[Estrogens of vegetable origin]. / Estrógenos de origen vegetal. Actualización.

In recent years, estrogens of vegetable origin have acquired some importance that justify the presentation of the available data. The compounds that have estrogenic effect when ingested as food through vegetables include isoflavones, lignines and lactones. The review comprises their chemical structure, metabolism and excretion as well as their effect on plasmatic levels of estrogens FSH, LH and SHBG as well as their activity over lipoproteins and, naturally, their action on menopause symptoms and breast cancer.

[Controlled-delivery drugs]. / Fármacos de administración controlada.

The possibility of using modern means for systemic therapy, requires methods of delivery with the ability to modify such delivery once it has started. Some of these methods are already available as is the case of patches for a variety of indications, providing the passage of the medicine through the skin. Other devices, more complicated and of wide clinical use, may enable controlled liberation of substances directed to specific organs. A brief review of these systems is presented.

[Oral hormonal contraceptives and carbohydrate metabolism]. / Anticoncepción hormonal oral y metabolismo de los hidratos de carbono.

The most frequent progestins used as contraceptives with or without estrogens and their effects on glucose tolerance tests and insulin secretion is reviewed. Although changes observed were moderate, they became normal after few cycles of contraceptive use. All combined contraceptives (progestin plus ethynyl estradiol) produced some deterioration of glucose in the tolerance tests and increase in insulin secretion, although these changes were within normal accepted levels. The most notable changes were seen with levonorgestrel, mono or thiphasic, and were minimal with desogestrel or gestodene. No changes occurred with pregnane type compounds, like medroxy progesterone acetate, with no estrogens as the most representative of this group. The determinations of insulin secretion are more reliable if peptide C in plasma is determined, as it is released by the pancreas in an equimolar amount with insulin and is not retained by the liver.

[Oral hormonal contraception: more or less estrogens?]. / En anticoncepción hormonal oral, más o menos estrógenos?

The availability of desogestrel with two doses of estrogen, makes a more elastic use in a number of situations in different users. In the author's experience, some preferences are mentioned. Use 20 mcg: a) in adolescents without acne; b) in thin users, less than 60 Kg. weight; c) in those with a large bosom and heavy cyclic bleedings; d) in obese patients, who have reached their ideal weight; e) in those women over 35 years or close to menopause and in those soon after menopause, if they are asymptomatic. Use 30 mcg: a) in adolescents with acne; b) in patients with a small or flat bosom and with scanty cyclic bleedings; c) in those heavier than 60 Kg. d) in obese patients on reducing treatment until they reach their ideal weight.

[The desogestrel-ethinyl estradiol combination and overweight: current data]. / La combinación desogestrel etinil estradiol y el peso corporal excedido: Resultados actuales.

The effects of various progestins combined with ethynil estradiol, on body weight, are reviewed. A new group of obese patients being treated for weight excess, using desogestrel-ethynil estradiol (150 mg plus 30 mcg) as a contraceptive, was studied in conditions similar to those published in 1992. Very satisfactory results were obtained, as these patients lost body weight until reached ideal weight, without interference from the contraceptive compound used.

Desogestrel-ethinylestradiol, an oral monophasic contraceptive. Clinical and lipid metabolic effects: a 5-year experience.

A comparative study of 5 years' duration using desogestrel (DSG), levonorgestrel (LN), and norethindrone (NET), combined with ethinyl estradiol (EE), was conducted. A total of 4499 cycles on DSG-EE, 3691 on LN-EE (1980 on triphasic and 1711 on monophasic schemes) and 1680 on NET-EE was evaluated. A contraceptive efficacy of 100% was obtained in all the groups. Minimal side effects were observed. In particular, body weight in those women on DSG-EE did not show noticeable changes and headaches were minimal. No alterations on blood pressure readings or on the routine laboratory tests were noticed in any of the groups. There was a significant increase in high-density lipoprotein-c (HDL-c) in women on DSG-EE. There was no change in NET-EE, and a significant decrease in women on LN-EE in both schemes. Changes in LDL-C, very low density lipoproteins, triglycerides, total lipids, total cholesterol, and glucose were not significant, although there was some increase at 60 cycles on triglycerides on those women on DSG-EE and on NET-EE. At the end of 5 years, 76% of women continued on DSG-EE. They indicated their satisfaction with this method.

[Calcium lonazolac and blood loss in users of intrauterine devices. Preliminary report]. / Lonazolac cálcico y pérdida sanguínea en usuarias de dispositivos intrauterinos. Informe preliminar.

PIP: 3 groups of IUD users participated in a preliminary study to evaluate the effect of calcium lonazolac, a nonsteroid antiinflammatory agent, on excessive menstrual bleeding. All participants were parous women aged 20-30 years in good health. Multiload 250 IUDs were inserted in 15 women averaging 24.5 years of age. They were also supplied with calcium lonazolac tablets in 200 mg doses to be taken continuously 3 times daily. 15 women averaging 26.1 years also had multiload 250 IUDs inserted. They were given the same instructions but their medication was a placebo. A third group of 30 women averaging 26.2 years of age who had experienced heavy bleeding during 6-36 months of IUD use were given 200 mg tablets of calcium lonazolac to be taken 3 times daily. The 30 women used various types of IUDs. All 60 women were provided with sanitary pads to be returned at their regular clinic visits. Hemoglobin and hematocrit levels were also determined at each visit. The method of Hallberg and Nilsson was used to measure menstrual blood loss. There were no significant changes in the volume or duration of bleeding or hemoglobin or hematocrit levels in the 15 women given the drug. The 15 women given the placebo had a significant increase in the quantity of blood loss and a significant increase in the duration bleeding in the 3rd month. The 30 women with histories of heavy bleeding had significant decreases in volume and duration of bleeding. Modifications in hemoglobin were not especially significant, while the hematocrit levels increased in the 2nd and 3rd months. None of the women reported significant side effects except 1 woman with a prior history of gastritis. Her gastric distress was controlled by an antacid after meals for 1 week. Comparison of results between the treated and control groups suggests that calcium lonazolac gives good results. Its use should be evaluated at lower doses with consumption limited to days of bleeding only.^ieng

Experience with a new low dose oral contraceptive: norgestimate & ethinyl estradiol.

Experience with cyclic administration of 0.125 mg of norgestimate plus 0.035 mg of ethinyl estradiol indicates that this new combined oral contraceptive is clinically effective and well tolerated. There were no unintended pregnancies in 3,026 cycles of use among 161 women. Patient acceptability of a relatively high cycle incidence of spotting (16.7%) was remarkable; only five patients withdrew from the study because of this irregularity. Breakthrough bleeding was infrequent (0.9% of total cycles). No other side effects were reported and amenorrheic cycles were not observed. In particular there were no complaints of gastrointestinal disturbance. Weight remained unusually stable. Laboratory findings remained within normal limits over 6 months of drug use. However, serum cholesterol and serum glutamic pyruvic transaminase levels declined and protein bound iodine increased significantly from pre-treatment levels.

PIP: A clinical investigation was conducted to test and evaluate a new low-dose oral contraceptive, a combination produce containing 0.125 mg of norgestimate and 0.035 mg of ethinyl estradiol, developed with a view to minimizing extragonadal effects. Of the 161 fertile women observed during 3062 menstrual cycles, 91 were 'fresh' subjects, 70 were 'switch' subjects. No pregnancies occurred. The average number of cycle days remained almost constant. There was a decrease in the number of days of flow in 55.7, an increase in 9.7, and no change in 34.5% of all treatment cycles. The amount of menstrual flow decreased in 33.8, increased in 11.2, and remained moderate in 61.6% of all cycles. The incidence of spotting was relatively high -- 79.5% of all subjects in 16.7% of all cycles. Breakthrough bleeding was insignificant. Dysmenorrhea and premenstrual tension, which had been reported in 24.4 and 58.3% of pre-treatment cycles respectively, diminished. No incidents of amenorrhea or gastrointinal disturbance were reported. The laboratory findings included the following significant results: 1) a decrease in serum cholesterol from 188.90 to 180.98 mg/100 ml at 6 months; 2) a reduction in serum glutamic pyruvic transaminase; and 3) an expected rise in protein bound iodine.

[A continuous experience of the use of norethindrone-ethinyl estradiol combination in small doses as a contraceptive]. / Experiencia continuada con el empleo de la combinación noretindrona-etinil estradiol a dósis baja como anticonceptivo

PIP: Since recent recommendations advocate that smaller doses of estrogen should be used, a combination of .5 mg of norethindrone and .015 mg ethinyl estradiol was tested on 198 patients for a total of 2546 cycles, the longest usage being over 2 years. The women ranged from 15 to 45 years of age, the average age being 28, and the average number of pregnancies, 5.2. The medication was taken daily for 21 days and then stopped for 7. The group was controlled for secondary effects, bleeding, weight changes, and nucleal or hormonal changes. 14.2% stopped taking it because of secondary problems like spotting, nausea, transhormonal bleeding, and depression. The only pregnancy was due to inadequate attention to the prescription by the patient. Tolerance of the medication was quite good overall and no severe difficulties resulted.^ieng

[Effects of lynestrenol used singly in low doses, as a contraceptive]. / Efectos del linestrenol utilizado solo a dósis baja, como anticonceptivo

PIP: The effects of lynestrenol, administered continuously in the dose of .5 mg/day, were studied in 50 women during 1146 menstrual cycles. 45 patients completed 24 cycles each. Before treatment and every 6 cycles all patients were subjected to questioning, physical examination, cytological, blood and urea nitrogen tests and urinalysis. 50% were also subjected to hepatic function tests (sulfobromophtalein excretion, glutamic oxalacetic transaminase, alkaline phosphatase, cephalin-cholesterol flocculation) and endometrial biopsies every 6 cycles. Subjective side effects were absent and weight and blood pressure remained unchanged. Laboratory tests and cytological studies showed normal results. Only 14% of the biopsies performed showed interferen ce with the normal hormonal transformation of the endometrium. The average duration of menstruation was 4-5 days; 7% of all cycles were shortened by 5-10 days and .2% by 11-14 days. 7% of the cycles were prolonged by 5-10 days and .8% by 11-20 days. Amenorrhea was present in .4% of the cycles. Irregular bleeding (either spotting or breakthrough bleeding) was present in 14% of the cycles. 6 patients (12%) stopped the treatment for this reason. It is concluded that the preparation studied is effective and very well tolerated. Patients must be advised regarding the possibility of irregularities in the menstrual cycle, the efficacy of the drug and the absence of other unwanted side effects, to decrease the dropout rate.^ieng