Availability of pharmacist prescription of contraception in rural areas of Oregon and New Mexico.

OBJECTIVE: To determine the availability of pharmacist prescribing of hormonal contraception in rural areas of two states. STUDY DESIGN: Cross-sectional survey. RESULTS: Overall, 42% of pharmacies prescribed contraception (Oregon: 46% and New Mexico 19%). A similar proportion of rural pharmacies reported offering pharmacist prescription of 37 contraception as urban locations (39% vs 46%, p = 0.26). Nearly 53% of rural and 45% of urban pharmacies report billing women, rather than insurance, directly for the cost of the pharmacist consultation. Over 80% of pharmacists in both rural and urban locations did not know if Medicaid covered the cost. CONCLUSION: Pharmacists in rural areas are as willing as their urban counterparts to prescribe hormonal contraception. Financial barriers remain a concern.

One-year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives / Alterações na densidade mineral óssea e nos marcadores de formação óssea em adolescentes usuárias ou não de contraceptivos hormonais orais combinados por período de um ano

Abstract Objective: The objective of this study was to evaluate the effects of two low-dose combined oral contraceptives on bone metabolism in adolescents for one year. Methods: This was a quasi-experimental study. The adolescents were divided into three groups: oral contraceptives 1 (n = 42) (20 µg EE/150 µg desogestrel), oral contraceptives 2 (n = 66) (30 µg EE/3 mg drospirenone), and a control group (n = 70). Adolescents underwent anthropometric assessment and densitometry (dual-energy X-ray). Bone age and bone formation markers (osteocalcin and bone alkaline phosphatase) were evaluated. The oral contraceptives users were evaluated again after 12 months. Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group. Results: At study entry, no significant differences were observed between the oral contraceptives 1, oral contraceptives 2, and controls in the analyzed variables. Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year. There was a significant reduction in bone alkaline phosphatase levels; no significant difference was observed for osteocalcin in control individuals. Comparison of dual-energy X-ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups. A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups. Conclusion: Adolescent women gain peak bone mass during this phase of life. Two low-dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls.

Resumo: Objetivo: O objetivo deste estudo foi avaliar os efeitos de dois contraceptivos orais combinados de baixa dosagem por um ano sobre o metabolismo ósseo em adolescentes. Métodos: Este foi um estudo quase experimental. As adolescentes foram divididas em três grupos: contraceptivos orais 1 (n = 42) (20 µg de EE/150 µg de desogestrel), contraceptivos orais 2 (n = 66) (30 µg EE/3 mg de drospirenona) e grupo controle (n = 70). As adolescentes foram submetidas à avaliação antropométrica e densitometria (raio-X de dupla energia). Foram avaliados a idade óssea e os marcadores de formação óssea (osteocalcina e fosfatase alcalina óssea). As usuárias de contraceptivos orais foram novamente avaliadas após 12 meses. A análise de regressão linear foi utilizada para estudar, indiretamente, o efeito de cada ano adicional da idade cronológica sobre as variáveis antropométricas e densitométricas e sobre os marcadores ósseos no grupo de controle. Resultados: No início do estudo, não foram observadas diferenças significativas nas variáveis analisadas entre as usuárias de contraceptivos orais 1, contraceptivos orais 2 e o grupo controle. A análise de regressão linear mostrou um aumento na densidade mineral óssea e no conteúdo mineral ósseo para cada ano adicional. Houve uma redução significativa nos níveis de fosfatase alcalina óssea e não foi observada diferença significativa para osteocalcina nos indivíduos controles. A comparação das variáveis do raio-X de dupla energia no início e após um ano não mostrou diferença significativa no grupo de contraceptivos orais 1 ou contraceptivos orais 2. Foi observada uma redução significativa nos níveis de fosfatase alcalina óssea e osteocalcina nos dois grupos contraceptivos orais 1 e contraceptivos orais 2. Conclusão: As adolescentes atingiram o pico de massa óssea durante essa fase da vida. Duas formulações de contraceptivos hormonais orais de baixa dosagem, após um ano de uso, se associaram a menor incremento na densidade mineral óssea e menor concentração de marcadores de formação óssea quando confrontados com resultados de adolescentes não usuárias de contraceptivos.

Hormonal oral contraceptive influence on isolation, Characterization and cryopreservation of mesenchymal stem cells from menstrual fluid.

The purpose of the study was to evaluate whether the intake of hormonal oral contraceptive influences the viability of mesenchymal stem cell. Sixteen healthy female volunteers with regular menstrual cycles were invited to participate. Menstrual fluid was collected on the day of maximum flux, and collected cells were analyzed by a 'minimal standard' for MSC characterization: plastic adherence, trilineage (adipogenic, osteogenic, chondrogenic) in vitro differentiation and a minimalistic panel of markers assessed by flow cytometry (CD731, CD901, CD1051, CD34-, CD45-) using monoclonal antibodies. The participants were divided into two groups: Group 1 - no hormonal contraceptive use; Group 2 - hormonal oral contraceptive use. The median of the menstrual fluid volume was 5.0 and the median number of cells was 5.2 × 106. Median of cell viability was 89.3%. After culture, mesenchymal stem cells increased from 0.031% of the total cells to 96.9%. The cells formed clusters and reached confluence after 15-21 days of culture in the first passage. In the second passage, clusters and the confluence were observed after 3 days of culture. No difference was observed between the groups. Our data suggest that oral hormonal contraceptive intake maintains the viability of mesenchymal stem cells from menstrual fluid.

One-year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives.

OBJECTIVE: The objective of this study was to evaluate the effects of two low-dose combined oral contraceptives on bone metabolism in adolescents for one year. METHODS: This was a quasi-experimental study. The adolescents were divided into three groups: oral contraceptives 1 (n=42) (20µg EE/150µg desogestrel), oral contraceptives 2 (n=66) (30µg EE/3mg drospirenone), and a control group (n=70). Adolescents underwent anthropometric assessment and densitometry (dual-energy X-ray). Bone age and bone formation markers (osteocalcin and bone alkaline phosphatase) were evaluated. The oral contraceptives users were evaluated again after 12 months. Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group. RESULTS: At study entry, no significant differences were observed between the oral contraceptives 1, oral contraceptives 2, and controls in the analyzed variables. Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year. There was a significant reduction in bone alkaline phosphatase levels; no significant difference was observed for osteocalcin in control individuals. Comparison of dual-energy X-ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups. A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups. CONCLUSION: Adolescent women gain peak bone mass during this phase of life. Two low-dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls.

Safety of hormonal contraception for obese women.

INTRODUCTION: Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis. Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis. Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.

Vocal Range in the Speech of Users of Low-Dose Oral Contraceptives.

OBJECTIVE: The study aimed to investigate the vocal range of oral contraceptive (OC) users aged between 20 and 30 years. STUDY DESIGN: This is a cross-sectional study. METHODS: Forty-eight women aged 20-30 years who used low-dose OCs and 24 age-matched women who did not use oral monophasic contraceptives (w/oOC) were enrolled. Acoustic analysis was performed using the Motor Speech Profile program, Model 4341 (Kay Elemetrics Corp). Data were analyzed using generalized estimating equation. RESULTS: In the w/oOC group, the highest vocal tones in the sentence uttered using exclamatory intonation were similar in the follicular phases of two cycles (F1: 289 ± 46 Hz; F2: 284 ± 61 Hz). In the luteal phase of the first cycle, the vocal tones were lower, whereas in the second cycle they were higher than the tones in both follicular phases (L1: 274 ± 42 Hz; L2: 291 ± 62 Hz) (P = 0.056). In the highest vocal tones of the same sentence uttered using exclamatory intonation, the OC group showed lower tones (284 ± 53 Hz) than the w/oOC group (298 ± 44 Hz) (P = 0.048). In the lowest vocal tones of utterances of joy, the OC group showed higher values (180 ± 39 Hz) than the w/oOC group (169 ± 44 Hz) (P = 0.024). The close proximity of the highest to the lowest values of utterances of joy in the OC group (321 ± 59 Hz and 180 ± 39 Hz), when related to the w/oOC group (338 ± 65 Hz and 169 ± 44 Hz), suggests a reduced vocal modulation. CONCLUSIONS: The present findings demonstrate that the use of low-dose OCs influences the vocal range of women during menacme.

Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods.

OBJECTIVE: To evaluate neurologists' knowledge of contraceptive counseling for women receiving antiepileptic drugs (AEDs). METHODS: An interview-based survey was conducted from February 2 to June 30, 2015, among neurologists working in Ribeirão Preto, Brazil. Direct interviews were conducted using a questionnaire that assessed knowledge of the pharmacological interactions between various contraceptive methods and six AEDs (carbamazepine, phenobarbital, topiramate, phenytoin, lamotrigine, and valproate) on the basis of WHO medical eligibility criteria for contraceptive use. RESULTS: Among 42 neurologists who participated, 32 (76%) stated that they treated women with epilepsy and provided them with counseling for family planning. Overall, 34 (81%) recommended the use of a copper intrauterine device irrespective of the AED used, and 26 (60%) stated that they co-prescribed AEDs and hormonal contraceptives. Although 39 (93%) neurologists had knowledge that AEDs might contraindicate the use of some contraceptives, their knowledge regarding the specific drug interactions was lacking. Furthermore, 34 (81%) had no knowledge of WHO medical eligibility criteria for contraceptive use. CONCLUSION: Although most neurologists interviewed had knowledge of interactions between AEDs and hormonal contraceptives, they did not know which specific AEDs interacted with these agents.

El uso de métodos anticonceptivos en la adolescencia / The use of contraceptive methods in adolescence

Dentro de los desafíos a enfrentar por los adolescentes está el relacionado con la práctica de su sexualidad y el riesgo que esto conlleva para su salud reproductiva. El descenso en la edad de la menarquia, el inicio sexual precoz y la prolongación de la edad del matrimonio, incrementan el tiempo durante el cual los adolescentes están sometidos al riesgo de una gestación no deseada y de contraer infecciones de transmisión sexual. El objetivo del trabajo es hacer una revisión actualizada sobre el uso de los métodos anticonceptivos durante la adolescencia y definir los más recomendables. Se revisaron los artículos sobre anticoncepción y adolescencia publicados en los últimos diez años, mediante la revisión de los más actualizados y de mayor rigor científico. El mejor método es aquel que la adolescente y de preferencia ambos miembros de la pareja, escojan debidamente informados. Los anticonceptivos hormonales combinados son seguros y eficaces para adolescentes, al igual que los métodos reversibles de acción prolongada. La anticoncepción de emergencia es de gran utilidad en situaciones excepcionales, pero no como método habitual. El uso correcto del condón masculino, es el único método capaz de disminuir el riesgo de transmisión de infecciones de transmisión sexual y el virus de inmunodeficiencia adquirida (ITS/VIH). El método combinado al utilizar los anticonceptivos hormonales y el condón masculino protegen de una gestación no deseada y de las infecciones, por lo que sería el método ideal para los adolescentes(AU)

Among the challenges faced by adolescents are practicing of their sexuality and the risk this entails for their reproductive healthare related. The decline at the menarcheage, early sexual initiation and extension of the marriageage increase the risk of unwanted gestation and sexually transmitted infections.The aim of this paper is to updatethe review on the use of contraceptive methods in adolescence and to define the most recommended ones. Articles on contraception and adolescence, which were published in the last ten years, were reviewed by reviewing the most contemporary and scientific consistency.The best method is one the adolescent, preferably both members of the couple, choose duly informed. Combined hormonal contraceptives are safe and effective for adolescents, as well as the long-acting reversible methods.Emergency contraception is useful in exceptional situations, but not as customary method. The correct use of the male condom is the only method capable of reducing the risk of transmission of sexually transmitted infections and human immunodeficiency virus (STD/HIV).The combined method, which uses hormonal contraceptives and male condoms, protects against unwanted pregnancy and infections, so it would be the ideal method for teenagers(AU)

Reproductive factors, hormone use and gastric cancer risk: The Singapore Chinese Health Study.

Gastric cancer incidence varies greatly worldwide, but is consistently twice as high in men than in women. The hormone-related factors hypothesized to be associated with lower risk of gastric cancer in women have not been fully explored in populations with a high background risk of gastric cancer. The Singapore Chinese Health Study (SCHS) is a prospective cohort study in which 34,022 of the participants enrolled between 1993 and 1998 were women between 45 and 74 years of age. Information on reproductive histories, hormone replacement therapy (HRT) and oral contraceptive (OC) use was collected through in-person interviews at baseline. As of December 31, 2013, 269 incident gastric cancer cases were identified. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate gastric cancer risk associations. Older age at natural menopause (≥55 versus <45 years: HR = 0.50, 95% CI: 0.25-0.99), type of menopause (other versus natural: HR = 0.48, 95% CI: 0.27-0.87) and greater years of menstrual cycling (fourth versus first quartile: HR = 0.67, 95% CI: 0.46-0.96) were associated with a decreased risk of gastric cancer. Ever use of OCs and HRT was also associated with reduced risk of gastric cancer; the multivariable-adjusted HRs (95% CIs) were 0.40 (0.17-0.90) for use of HRT >3 years and 0.67 (0.47-0.94) for ever use of OCs, compared with never use. Reproductive factors associated with a longer window of fertility and the use of exogenous hormones were shown to reduce gastric cancer development in a cohort of Chinese women with a high background risk of gastric cancer.

Low-dose progestin-releasing contraceptives are associated with a higher pain threshold in healthy women.

OBJECTIVE: To determine the pain thresholds of women taking different formulations of hormonal contraceptives. DESIGN: Cross-sectional study. SETTING: Basic health care unit. PATIENT(S): Eighty-nine healthy nonusers and 188 users of hormonal contraceptives. INTERVENTION(S): Subject interviews were followed by the application of a semistructured questionnaire, including a psychometric assessment with the Beck Depression Inventory and the State-Trait Anxiety Inventory. After the interview, a 10-mL peripheral blood sample was collected. Pain thresholds were obtained by performing pressure algometry. MAIN OUTCOME MEASURE(S): Serum concentrations of E2, P, and T (free fraction) were determined via chemoluminescence. The menstrual cycle phase was determined according to hormonal level and identification of an LH surge in urine. Pain threshold was evaluated with a dynamometer applied to the forearm skin of the nondominant limb and abdominal wall. RESULT(S): Progestin-only contraceptive users showed a higher pain pressure threshold in the forearm (2.94 ± 0.96 vs. 2.74 ± 0.89 vs. 2.62 ± 0.92) and right (2.11 ± 0.87 vs. 1.83 ± 0.81 vs. 1.78 ± 0.77) and left abdomen (2.12 ± 0.88 vs. 1.79 ± 0.76 vs. 1.73 ± 0.70) than did combined hormonal contraceptive users and nonusers of hormonal contraceptives, respectively. Users of contraceptives that continuously release etonogestrel (subcutaneous implant, vaginal ring) or levonorgestrel (intrauterine devices) had higher pain thresholds. CONCLUSION(S): Women who used hormonal contraceptives enabling continuous release of etonogestrel or levonorgestrel tended to have higher pain thresholds than did nonusers of hormonal contraceptives.

[Impact of contraception counseling on choice of combined hormonal methods in Colombia]. / Impacto de la asesoría sobre anticoncepción en la selección de métodos hormonales combinados en Colombia.

OBJECTIVE: Determine the impact of informed contraceptive counseling on choice of contraceptive method. METHODS: Multicenter descriptive study using before-and-after evaluation in nine cities in Colombia. Women considering use of self-administered combined hormonal methods at the time of consultation were invited to participate. They were asked about contraceptive method use and preference, following signing of informed consent. Later, they were given standardized medical advice on contraception and then asked again about contraceptive preference and reasons for their choice. RESULTS: The study enrolled 858 women. At the beginning of the study, 538 (62.7%) women were using the combined pill and 281 (32.8%) were not using any contraceptive method. Before receiving counseling, women showed a preference for the pill (62.7%), followed by the intravaginal ring (28.4%), and transdermal patch (14%). After counseling, preferences were as follows: pill (40.8%), intravaginal ring (31.5%), and transdermal patch (11.3%). After counseling, 32.5%, 26.8%, and 7.5% of those considering the pill, patch, and ring, respectively, changed their intended choice. Region of origin, employment status, desire to conceive a child in the future, and having a stable relationship showed a statistical relationship to choice of method. However, age, number of children, and level of education were not determining factors. CONCLUSIONS: Medical advice has an impact on choice of self-administered combined hormonal contraceptives, which helps women to use the method of their choice and improves adherence to the method in accordance with its particular conditions.

Validation of an immunoassay for anti-Müllerian hormone measurements and reference intervals in healthy Brazilian subjects.

BACKGROUND: Anti-Müllerian hormone is marker of ovarian and testicular reserve. The clinical use of this hormone requires proper standardization of reference intervals. The aims of this study were to validate the Anti-Müllerian hormone Gen II immunoassay, to establish Anti-Müllerian hormone reference intervals in healthy subjects, and to evaluate the influence of hormonal contraceptives, smoking, and body mass index on Anti-Müllerian hormone. METHODS: The validation of the Anti-Müllerian hormone Gen II assay (Beckman Coulter Company, TX, USA) was performed using a simplified protocol recommended by Clinical Laboratory Standard Institute. One-hundred and thirty-three healthy females and 120 males were prospectively selected for this study. RESULTS: The analytical and functional sensitivities of the Anti-Müllerian hormone Gen II immunoassay were 0.02 and 0.2 ng/mL, respectively. Intra-assay coefficients ranged from 5.2 to 9.0%, whereas inter-assay precision ranged from 4.6 to 7.8% at different concentrations. In females, Anti-Müllerian hormone showed progressive decline with increasing age (r=-0.4, p<0.001), whereas in males, age showed no influence on Anti-Müllerian hormone concentrations. In females, Anti-Müllerian hormone concentrations did not differ between users and non-users of hormonal contraceptives, smokers, and non-smokers and obese and lean individuals. However, there was a negative and significant correlation between Anti-Müllerian hormone and body mass index in males (r=-0.3, p=0.008). CONCLUSIONS: Anti-Müllerian hormone Gen II assay was reliable for determining serum Anti-Müllerian hormone concentrations. Anti-Müllerian hormone concentrations declined with aging and presented a wide inter-individual variability. The lack of influence of hormonal contraceptives, smoking, and obesity on Anti-Müllerian hormone in both sexes allowed us to refine the normative concentrations for the Brazilian population.

Different Pearl Indices in studies of hormonal contraceptives in the United States: impact of study population.

OBJECTIVE: To examine the impact of subject characteristics on efficacy as measured by the Pearl Index (PI) in clinical trials and to make study populations similar by matching. METHODS: Our analysis used US data from four large Phase III studies. We compared results from one fertility control patch study with pooled data from three studies with virtually identical design on oral hormonal contraceptives. First, we identified three characteristics that had the most impact on the PI. Second, we used these three variables and matched subjects from the patch study with those from the oral contraceptive (OC) studies. Finally, we calculated the PIs for matched and unmatched subjects from both the patch study and the OC studies. RESULTS: A total of 3706 subjects were included in our analysis. The variables 'Hispanic ethnicity', 'previous pregnancy' and 'previous use of hormonal contraceptives' had the most impact on the PI. The PIs for the matched patch cohort and the matched OC cohort were 2.97 and 2.48, respectively. Those for the unmatched patch cohort and the unmatched OC cohort were 10.17 and 0.90, respectively. CONCLUSION: Subject characteristics strongly influence the PI in clinical studies of hormonal contraceptives. In particular, Hispanic ethnicity, previous pregnancies and no previous use of hormonal contraceptives result in a higher PI. IMPLICATIONS: PIs from different clinical trials cannot be meaningfully compared unless subject characteristics that have most impact on the PI are similar or are made to be similar statistically as we did here by matching.

Anticoncepción de emergencia / Emergency contraception

The prevention of unwanted pregnancy, it is base in the application of fertility regulation programs, which has failed to reach the teenage group. Today, three emergency contraception methods are used in the world (EC): hormonal methods, copper intrauterine device and the modulators of progesterone receptors. Lately it has raised the use of non-steroidal anti-inflammatory drugs, specifically Meloxicam, with very good results. This chapter discuss about hormonal EC, because they are the most popular methods, and the only one that we got in our country. There are two hormonal EC schemes; the first one, use combined contraceptive method, known since the 70s as the Yuzpe scheme. The second one, use Levonorgestrel alone, with less adverse reactions and recommended by the WHO. Hormonal EC have multiple biologic effects, but the main mechanism of action is the ovulation inhibition or the delay of it. The EC has not show prevention of implantation of the fertilize egg, so there are not scientific evidence that they are abortive. The reasons to prescribe EC are related with unprotected intercourse. The use of these methods are safe, a few side effects have been described. EC is less effective than regular contraception methods, therefore an important concept when you prescribing an EC is counselling on sexual and reproductive health to achieve double regular method use and prevent recurrent need of EC...

La prevención del embarazo no deseado pasa por la aplicación efectiva de programas de regulación de fecundidad, sin embargo estos no han logrado influir lo suficiente a los adolescentes. Hoy en el mundo se utilizan tres sistemas de anticoncepción de emergencia (AE): Hormonal , Dispositivo intrauterino con cobre y moduladores de receptores de progesterona . Últimamente se ha propuesto el uso de antiinflamatorios no-esteroidales, específicamente meloxicam, con buenos resultados. Este capítulo trata principalmente sobre AE hormonal, ya que es el sistema más usado y el único disponible en nuestro país . Existen dos esquemas , el primero basado en anticonceptivos orales combinados, usado desde los años 70 y conocido como esquema Yuzpe. El segundo de levonorgestrel puro con menos efectos adversos y el que actualmente recomienda la OMS. El mecanismo de acción principal de estos métodos, es la inhibición o retraso de la ovulación, asociado a otros cambios biológicos producto de la acción hormonal. No se ha demostrado alteración en la implantación del cigoto fecundado, por lo tanto no existe evidencia de que sea abortivo. Las indicaciones de AE se concentran en los coitos no protegidos por diferentes causas. Existe suficiente seguridad para su uso, con pocos efectos adversos, aunque su efectividad es baja en relación al uso de métodos anticonceptivos regulares. Lo más importante de la indicación de AE es la consejería en salud sexual y reproductiva para lograr la adherencia a métodos de planificación familiar más seguros y evitar el uso reiterado del método de emergencia...(AU)

Post-cervical conization outcomes in patients with high-grade intraepithelial lesions.

To investigate the rates of residual, recurrent and invasive disease after cervical conization in patients diagnosed with cervical intraepithelial neoplasia (CIN) grades 2/3. A retrospective study was conducted with 274 patients undergoing cervical conization due to diagnosis of CIN 2/3. Cervical conization was done through the Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Conization. Data related to personal, familial, gynecological, and obstetric antecedents, as well as surgical specimens margins were collected from medical records. The outcome after conization was evaluated, including the time of follow-up and disease recurrence. The outcome after conization was not associated with age of menarche (p = 0.920), age of the first sexual intercourse (p = 0.533), number of parturition (p = 0.063), number of sexual partners (p = 0.328), immunosuppression (p = 0.225), smoking habit (p = 0.193), and conization type (p = 0.198). However, the outcome presented a significant association with age (p < 0.001), pregnancy numbers (p = 0.009), use of hormonal contraception methods (p = 0.016), menopause (p = 0.007), type of margins (p = 0.011), and cone histological results (p = 0.030). The routine control of all patients who had undergone cervical conization is obligate, independently of surgical margins, due to the risk of disease recurrence; the older patients and those with CIN 3 should have a more rigorous follow-up.

Evaluation of hormonal suppression with two contraceptive regimens using ethinyl estradiol and desogestrel.

PURPOSE: Because of the lack of data on hormone levels in the hormone-free interval of the contraceptive regimens with desogestrel and ethynil estradiol, the objective of this study was to compare hormonal levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and inhibin B using two contraceptive regimens with those steroids. METHODS: Prospective and randomized study with 21 patients. Eleven patients received a 21/7 regimen (group 1) and ten patients received a 21/2 placebo/5 ethinyl estradiol 10 µg regimen (group 2). RESULTS: We found a significant increase in FSH and LH levels in both groups. There was a significant reduction of inhibin B in the 21/2/5 regimen. No difference in estradiol levels was found. CONCLUSIONS: Steroids withdrawal in the hormone-free interval causes reduced inhibition of the HPO axis. The significant decrease in inhibin B levels of group 2 suggests better suppression of the HPO axis in the 21/2/5 regimen.

Progestin-only contraception prevents bone loss in postpartum breastfeeding women.

BACKGROUND: There are an increase in bone loss during the first 6 months postpartum and a complete recovery postweaning. A few studies of steroid contraceptive use during this period provide some evidence towards protection of bone loss with progestin-only contraceptive methods. OBJECTIVE: The study was conducted to evaluate forearm bone mineral density (BMD) of breastfeeding postpartum women using nonhormonal and progestin-only contraceptive methods. STUDY DESIGN: A prospective cohort study of postpartum women had an analysis performed at 6 months postpartum correlating BMD with contraceptive use. Forearm BMD was measured 7-10 days, 3 months and 6 months postpartum. Eighty-two women were analyzed, comparing nonhormonal (54) and progestin-only (28) contraceptive methods. Information about breastfeeding duration, amenorrhea and body mass index was collected. RESULTS: Baseline characteristics of the study population showed no statistical differences between the groups. The median duration of breastfeeding for both groups was 183 days. A significant BMD decrease was observed for the nonhormonal group (p<.001); however, no statistical difference was detected for the progestin-only group. Body mass index, BMD at 7-10 days postpartum and total duration of breastfeeding were positively correlated with BMD at 6 months. CONCLUSIONS: Our findings suggest a preventive effect towards postpartum bone loss with progestin-only contraception in breastfeeding women.

Anticoncepção hormonal e câncer de mama / Hormonal contraception and breast cancer

O câncer de mama é a segunda neoplasia em incidência na população feminina com mais de 1.100.000 casos/ano no mundo, com aproximadamente 410.000 mortes/ano. A hormônio-dependência do câncer de mama é um fato bem estabelecido em diversas situações como a obesidade e a reposição hormonal. A associação entre o anticencepcional hormonal e o câncer de mama tem sido debatida por décdas, sem que haja um consenso. Lançado nos anos 1960, o contraceptivo hormonal oral foi um marco histórico no padrão de vida da mulher moderna e seu uso popularizou-se mundialmente, sendo utilizado por milhões de mulheres em todo o mundo. Este artigo objetiva abordar a relação entre o uso da anticoncepção hormonal e o desenvolvimento do câncer de mama. Para tanto, foram revistos os trabalhos publicados na literatura no período compreendido entre 1997 a 2011. Foram identificados e revisados os artigos mais relevantes; suas referências foram checadas com o objetivo de produzir um texto que avalie as evidências da relação entre a anticoncepção hormonal e o desenvolvimento do câncer de mama.

Breast cancer is the second cancer incidence in the female population of over 1,1 million cases per year worldwide, with approximately 410,000 deaths per year. The hormone dependence of breast cancer is a well established fact in several situations, such as obesity and hormone replacement. The association between hormonal contraceptives and breast cancer has been debated for decades, without a consensus. Released in sixties, the hormonal contraceptive has been a landmark in the quality of life of modern woman and its use has become popular worldwide and is used by millions of women around the world. This article aims to address the relationship between use of hormonal contraceptives and the development of breast cancer. Therefore, we reviewed the published literature in the period between 1997 and 2011. The most relevant articles were identified and reviewed. Their references were checked producing a text to assess the evidence of the relationship between hormonal contraception and the development of breast cancer.

Tratamento hormonal da acne baseado em evidências / Hormonal treatment of acne based on evidence

Este trabalho de revisão apresenta o tratamento hormonal da acne baseado em evidências. O trabalho resume a clínica, a classificação, a fisiopatologia e a etiologia da acne. A avaliação de estudos selecionados mostrou que o tratamento hormonal da acne deve ser complementado por tratamento cosmiátrico, e não está indicado para gestantes ou mulheres com planos de engravidar. A primeira escolha para esse tratamento são os contraceptivos hormonais orais, pois são efetivos e seguros para tratamento da acne e também para anticoncepção. Após tempo estabelecido, se o resultado for insatisfatório, outro medicamento, como acetato de ciproterona ou espironolactona, deve ser adicionado. A finasterida é o medicamento indicado para acne de origem idiopática, e a flutamida apresenta efeitos colaterais significativos, não constituindo indicação segura até o momento.

This review shows the hormonal treatment of acne. The review summarizes the clinical aspects, classification, physiopathology and etiology of the acne. The evaluation of selected papers showed that hormonal treatment of acne with hormones has to be complemented by esthetics treatment and is not prescribed for pregnant women or those who want to get pregnant. The first choice of treatment is the hormonal oral contraceptive one, because it is effective and safe for treatment of acne and also for contraception. After an established period with unsatisfactory results, other medicines, such as ciproterone acetate or spironolactone, can be added. The finasteride is prescribed for idiopathic acne and flutamide has many relevant side effects and is also not safe.