Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.600
Filtrar
1.
East Mediterr Health J ; 27(10): 993-1000, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34766325

RESUMO

Background: Discontinuation of hormonal contraceptives is an important contributor to unmet need of contraception. Aims: To determine the discontinuation rate and the reasons for discontinuation of hormonal contraception among Omani women. Methods: This was a 2-stage sampling, multicentre, retrospective cohort study conducted in 2018 at primary health care centres in Muscat Region, Oman. It included newly registered users of hormonal contraceptives in birth spacing clinics from January to December 2016 and the course of care over the following 12 months. A telephone interview was conducted to complement some of the missing data. The contraceptive methods available were combined oral contraceptives, progesterone only pills and injectable depot medroxyprogesterone acetate. Results: We included 404 women and 87.8% were breast-feeding. By the end of the first year, (268; 66.3%) women discontinued their contraceptive method. More than half (55.2% 148/268) of the discontinuation was attributed to adverse effects and the most prevalent was menstrual abnormality (102/268; 38.1%). Only 5.6% (15/268) discontinued contraception because they desired pregnancy. Partners and logistics of availability and access played a minimal role in discontinuation. Age and number of children did not influence the discontinuation rate. Conclusion: This study improves our knowledge about the rate of discontinuation of hormonal contraception and its related factors in Oman, which can be used for population-specific counselling. Future research should study the contraception behaviour of breast-feeding women to assess when and why they discontinue their contraceptive methods.


Assuntos
Anticoncepcionais Femininos , Anticoncepção , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Contracepção Hormonal , Humanos , Omã/epidemiologia , Gravidez , Prevalência , Estudos Retrospectivos
2.
PLoS One ; 16(9): e0257778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34582488

RESUMO

BACKGROUND: The long-term use of contraceptive methods that contain estrogens, progestogens or combinations of the above among women aged 15 to 49 years is extensive. Both estrogens and progestogens affect bone metabolism. OBJECTIVE: To systematically investigate and appraise the quality of the available evidence from animal studies regarding the impact of exogenous administration of female sex hormones on the rate of orthodontic tooth movement and root resorption. SEARCH METHODS: Search without restriction in seven databases (including grey literature) and hand searching were performed until May 2021. SELECTION CRITERIA: We looked for controlled animal studies investigating the effect from exogenous administration of formulations containing female sex hormones on the rate of orthodontic tooth movement and root resorption. DATA COLLECTION AND ANALYSIS: After study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. The quality of available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation. RESULTS: Three studies were identified, all being at unclear risk of bias. Overall, administration of progesterone and the combinations of estradiol with norgestrel and desogestrel were shown to significantly decrease the rate of orthodontic tooth movement when given for longer periods (>3 weeks). Inconsistent information was detected for shorter periods of consumption. Estradiol, with desogestrel use, resulted in less root resorption. The quality of the available evidence was considered to be low. CONCLUSIONS: Exogenous administration of female sex hormones may decelerate in the long term the rate of tooth movement and decrease orthodontically induced root resorption in animals. Until more information becomes available, an orthodontist should be able to identify a patient consuming such substances and understand the potential clinical implications and adverse effects that may arise. REGISTRATION: PROSPERO: CRD42017078208; https://clinicaltrials.gov/.


Assuntos
Anticoncepcionais Orais Hormonais/administração & dosagem , Progestinas/efeitos adversos , Reabsorção da Raiz/epidemiologia , Mobilidade Dentária/epidemiologia , Adolescente , Adulto , Animais , Animais de Laboratório , Anticoncepcionais Orais Hormonais/efeitos adversos , Modelos Animais de Doenças , Feminino , Hormônios Esteroides Gonadais , Humanos , Pessoa de Meia-Idade , Reabsorção da Raiz/etiologia , Fatores de Tempo , Mobilidade Dentária/etiologia , Adulto Jovem
3.
S D Med ; 74(7): 302-303, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34449989

RESUMO

This is a case report of a female patient with multiple hepatocellular adenomas secondary to the glycogen storage disease 1a with asymptomatic and late adult-onset presentation. Even though the patient was taking a hormonal oral contraceptive, it was important to identify the genetic disorder and ensure adequate metabolic control which is considered a modifier of the adenoma formation and progression. It is also imperative that the patient gets monitored for the adenoma-to-hepatocellular carcinoma transformation.


Assuntos
Adenoma de Células Hepáticas , Adenoma , Carcinoma Hepatocelular , Neoplasias Hepáticas , Adenoma de Células Hepáticas/induzido quimicamente , Adenoma de Células Hepáticas/diagnóstico por imagem , Adulto , Carcinoma Hepatocelular/induzido quimicamente , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Humanos , Neoplasias Hepáticas/induzido quimicamente
4.
Expert Opin Drug Saf ; 20(11): 1451-1453, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34264151

RESUMO

Introduction: Concerns about the increased risk of blood clots associated with the VAXZEVRIA (previously named Oxford-AstraZeneca COVID-19 vaccine) and Johnson & Johnson (Janssen) COVID-19 vaccines raises the question of the thrombotic safety of other COVID-19 vaccines such as Pfizer-BioNTech or Moderna, especially in younger women, who at the early stage of the pandemic was a priority group for vaccination. Methods: Using the US-based Vaccine Adverse Event Reporting System (VAERS) and the FDA Event Reporting System (FAERS), we retrieved cases of thrombosis following vaccinations or hormonal contraceptive use in women aged ≤ 50 years. We used the reporting odds ratio (ROR) as a disproportionality measure. Results: On 19 March 2021, out of 13.6 million women aged ≤ 50 exposed to at least one dose of Pfizer-BioNTech or Moderna COVID-19 vaccines in the US, only 61 cases were reported with a total of 68 thromboembolic events (1 case per 222,951 vaccinated). None of the thromboembolic events included in our analysis were disproportionally reported for the two COVID-19 vaccines. Conclusion: Our results do support that, when compared to hormonal contraceptive use, the mRNA vaccines do not show disproportional reporting of thromboembolic events in younger women.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Tromboembolia/sangue , Vacinação/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos , Fatores Etários , Vacinas contra COVID-19/administração & dosagem , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Contracepção Hormonal/efeitos adversos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores Sexuais , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Resultado do Tratamento
6.
Eur J Contracept Reprod Health Care ; 26(5): 413-420, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34160334

RESUMO

PURPOSE: To describe trends in hormonal contraceptive use, incidence of thromboembolism and presence of risk factors for thromboembolism among the users in Estonia. MATERIAL AND METHODS: Data of 223 312 female patients aged 15-49 years in 2005-2019 from national health insurance databases was derived. Annual prevalence rates of hormonal contraceptive users, incidence rates of thromboembolism and prevalence rates of risk factors were calculated. RESULTS: Between 2005-2019 usage of progestogen-only contraceptives (POCs) increased steadily (from 24 to 135 users per 1000 population), whereas combined hormonal contraceptive (CHC) use declined (from 209 in 2012 to 161 users per 1000 population in 2019). During the study period, 390 cases of venous thromboembolism and 108 arterial thromboembolism coincided with hormonal contraceptive use. Incidence rate for venous thromboembolism was 5.0 (95% CI 4.5-5.5) and for arterial thromboembolism 1.4 per 10 000 person-years (95% CI 1.1-1.7) among hormonal contraceptive users. Age adjusted incidence of venous thromboembolism among CHC users was 5.8 (95% CI 4.1-8.2) times higher than in POC users. Among CHC users, 10.3% had more than one risk factor for thrombosis. CONCLUSIONS: In regards to the risk of thromboembolism, wider use of POCs and declining prevalence of CHCs in Estonia is positive trend. Still, women with history of thrombosis receiving CHC is a serious concern.


Assuntos
Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Contracepção Hormonal/tendências , Tromboembolia/induzido quimicamente , Tromboembolia Venosa/induzido quimicamente , Adolescente , Adulto , Anticoncepcionais Orais Hormonais/administração & dosagem , Estônia/epidemiologia , Feminino , Contracepção Hormonal/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Tromboembolia/epidemiologia , Tromboembolia Venosa/epidemiologia , Adulto Jovem
7.
J Clin Endocrinol Metab ; 106(9): e3335-e3345, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34060603

RESUMO

CONTEXT: Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). OBJECTIVE: To study features of PCOS in young adult women with a history of PA. METHODS: Thirty PA and 42 control females were followed from prepuberty to young adulthood (median age 18.1 years). The main outcome measures were ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. RESULTS: We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/L, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through body mass index adjustment. SHBG correlated negatively with the homeostasis model assessment for insulin resistance (r -0.498, P = .003). Anti-Müllerian hormone concentrations were comparable between the groups (39.3 vs 32.1 pmol/L, P = .619). CONCLUSION: PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.


Assuntos
Adrenarca , Síndrome do Ovário Policístico/patologia , Esteroides/sangue , Acne Vulgar/complicações , Acne Vulgar/epidemiologia , Adolescente , Amenorreia/complicações , Androgênios/sangue , Hormônio Antimülleriano/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Seguimentos , Hirsutismo/complicações , Hirsutismo/epidemiologia , Humanos , Hiperandrogenismo/sangue , Hiperandrogenismo/patologia , Resistência à Insulina , Testes de Função Ovariana , Prevalência , Globulina de Ligação a Hormônio Sexual/análise , Adulto Jovem
8.
Fertil Steril ; 116(1): 208-217, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33752880

RESUMO

OBJECTIVE: To assess whether the duration, recency, or type of hormonal contraceptive used is associated with antimüllerian hormone (AMH) levels, given that the existing literature regarding the association between hormonal contraceptive use and AMH levels is inconsistent. DESIGN: Cross-sectional study. SETTING: Baseline data from the Study of the Environment, Lifestyle and Fibroids Study, a 5-year longitudinal study of African American women. PATIENT(S): The patients were 1,643 African American women aged 23-35 years at the time of blood drawing (2010-2012). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Serum AMH level was measured by an ultrasensitive enzyme-linked immunosorbent assay. Linear regression models were used to estimate percent differences in mean AMH levels and 95% confidence intervals (CIs) according to use of hormonal contraceptives, with adjustment for potential confounders. RESULT(S): In multivariable-adjusted analyses, current users of hormonal contraceptives had 25.2% lower mean AMH levels than non-users of hormonal contraceptives (95% CI: -35.3%, -13.6%). There was little difference in AMH levels between former users and non-users of hormonal contraceptives (-4.4%; 95% CI: -16.3%, 9.0%). AMH levels were not appreciably associated with cumulative duration of use among former users or time since last use among non-current users. Current users of combined oral contraceptives (-24.0%; 95% CI: -36.6%, -8.9%), vaginal ring (-64.8%; 95% CI: -75.4%, -49.6%), and depot medroxyprogesterone acetate (-26.7%; 95% CI: -41.0%, -8.9%) had lower mean AMH levels than non-users. CONCLUSION(S): The present data suggest that AMH levels are significantly lower among current users of most forms of hormonal contraceptives, but that the suppressive effect of hormonal contraceptives on AMH levels is reversible.


Assuntos
Hormônio Antimülleriano/sangue , Contraceptivos Hormonais/administração & dosagem , Anticoncepcionais Orais Hormonais/administração & dosagem , Adulto , Afro-Americanos , Biomarcadores/sangue , Contraceptivos Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Estudos Transversais , Regulação para Baixo , Esquema de Medicação , Duração da Terapia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Fatores de Tempo , Adulto Jovem
9.
JAMA Ophthalmol ; 139(1): 42-48, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33180101

RESUMO

Importance: Oral contraceptives have been associated with cardiovascular disease, ischemic stroke, venous thromboembolic disease, and breast cancer. Retinal vascular occlusions share the same risk factors as cardiovascular and cerebrovascular disease. Objective: To determine whether filling a prescription of female hormone therapy (FHT) is associated with an increased risk of retinal artery occlusion (RAO) or retinal vein occlusions (RVO). Design, Setting, and Participants: A multiple-cohort study was conducted using an administrative claims insurance database comparing women who filled a prescription for FHT with matched control individuals. Exclusion occurred for those enrolled for less than 2 years in the plan, with no prior ophthalmologic examination, with a history of a RAO/RVO, with systemic diseases/medications that affected estrogen levels, or a disease associated with an increased risk for thromboembolism. Main Outcomes and Measures: The primary outcome was the incidence of a new diagnosis of RAO or RVO. Cox proportional hazard regression modeling with inverse probability of treatment weight was used to assess the hazard ratio (HR) for a new diagnosis of RAO or RVO relative to filling prescription for FHT. Subanalyses were conducted to stratify by age, race/ethnicity, diabetes, and hypertension. Results: A total of 205 304 women who filled a prescription for FHT were matched to 755 462 control individuals. After inverse probability of treatment weight, the study cohort was a mean age of 47.2 years, 71% were White, 7% were Black, 6% were Hispanic, 3% were Asian, and 3% were unknown. There were 41 cases (0.01%) of RAO and 68 cases of RVO (0.02%) in the FHT cohort. In comparison, there were 373 cases of RAO (0.05%) and 617 cases of RVO (0.08%) in the control cohort. After inverse probability of treatment weight, Cox regression analysis showed no difference in hazard for RAO, RVO, or combined outcomes in the FHT cohort relative to the control cohort (RAO HR, 1.17; 95% CI, 0.83-1.65; P = .36; RVO HR, 1.07; 95% CI, 0.82-1.39; P = .65; combined HR, 1.10; 95% CI, 0.89-1.36; P = .37). Subanalyses that stratified by age, diabetes, and hypertension similarly showed no significant associations between the FHT prescription cohort and all outcomes. Conclusions and Relevance: These findings suggest that filling a prescription for FHT, and presumably taking FHT, does not increase the risk of RAO or RVO. Such history may not be relevant in the evaluation of an individual with an RAO or RVO nor do our results support stopping FHT in an individual who develops an RAO or RVO.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Terapia de Reposição de Estrogênios , Oclusão da Artéria Retiniana/epidemiologia , Oclusão da Veia Retiniana/epidemiologia , Demandas Administrativas em Assistência à Saúde , Adulto , Anticoncepcionais Orais Hormonais/efeitos adversos , Bases de Dados Factuais , Prescrições de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Incidência , Seguro de Serviços Farmacêuticos , Pessoa de Meia-Idade , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Veia Retiniana/diagnóstico , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
10.
Am J Clin Dermatol ; 22(1): 69-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32894455

RESUMO

Hormones play a significant role in normal skin physiology and many dermatologic conditions. As contraceptives and hormonal therapies continue to advance and increase in popularity, it is important for dermatologists to understand their mechanisms and dermatologic effects given the intricate interplay between hormones and the skin. This article reviews the dermatologic effects, both adverse and beneficial, of combined oral contraceptives (COCs), hormonal intrauterine devices (IUDs), implants, injections, and vaginal rings. Overall, the literature suggests that progesterone-only methods, such as implants and hormonal IUDs, tend to trigger or worsen many conditions, including acne, hirsutism, alopecia, and even rosacea. Therefore, it is worthwhile to obtain detailed medication and contraceptive histories on patients with these conditions. There is sufficient evidence that hormonal contraceptives, particularly COCs and vaginal rings, may effectively treat acne and hirsutism. While there are less data to support the role of hormonal contraceptives in other dermatologic disorders, they demonstrate potential in improving androgenetic alopecia and hidradenitis suppurativa.


Assuntos
Anticoncepção/efeitos adversos , Anticoncepcionais Orais Combinados/uso terapêutico , Progesterona/efeitos adversos , Dermatopatias/induzido quimicamente , Dermatopatias/tratamento farmacológico , Anticoncepção/instrumentação , Anticoncepção/métodos , Dispositivos Anticoncepcionais Femininos/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Dermatologia/métodos , Feminino , Humanos , Progesterona/administração & dosagem , História Reprodutiva , Medição de Risco , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias/diagnóstico
12.
Eur J Epidemiol ; 36(8): 827-839, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33331993

RESUMO

Oral contraceptives (OCs) have been associated with long-term lower endometrial cancer risk; relatively little is known about associations with more recent OC formulations and associations with longer-term risk. A total of 107,069 women from the Nurses' Health Study II recalled OC use from age 13 to baseline (1989); biennial questionnaires updated data on OC use until 2009. OCs were classified by estrogen and progestin type, dose, and potency based on reported brand. 864 incident endometrial cancer cases were identified through 2017. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals [95% CI] for the association of OC use with endometrial cancer risk. OC use was associated with lower endometrial cancer risk (ever use, HR 0.77 [95% CI 0.65-0.91]; >10 years of use, 0.43 [0.32-0.58] vs. never OC use). Inverse associations for duration were evident regardless of time since last use. Longer durations (> 5 years) of ethinyl estradiol (0.52 [0.41-0.67]) and second-generation progestins (0.43 [0.30-0.61]), both versus never use, were more strongly associated with lower risk than mestranol (0.66 [0.50-0.88], p-het = 0.01) and first-generation progestins (0.62 [0.49-0.78], p-het = 0.03). Inverse associations were generally observed for cross-classified cumulative average estrogen and progestin dose and potency (< vs. ≥ median; ever use vs. never OC use), with the exception of high estrogen and low progestin dose. OCs were associated with lower endometrial cancer risk, independent of time since last use. Use of ethinyl estradiol and second-generation progestins were more strongly inversely associated with risk compared with older formulations.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Neoplasias do Endométrio/induzido quimicamente , Adulto , Idoso , Estudos de Coortes , Anticoncepcionais Orais Hormonais/administração & dosagem , Neoplasias do Endométrio/epidemiologia , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Etinilestradiol/administração & dosagem , Etinilestradiol/efeitos adversos , Feminino , Humanos , Mestranol/administração & dosagem , Mestranol/efeitos adversos , Pessoa de Meia-Idade , Progestinas/administração & dosagem , Progestinas/efeitos adversos , Estudos Prospectivos
13.
Rev Epidemiol Sante Publique ; 68(6): 347-355, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33162269

RESUMO

BACKGROUND: In December 2012, a media controversy about negative side-effects of oral contraceptives on women's health, also called "pill scare", broke out in France. While several analyses highlighted a change in women's contraceptive practices following this media controversy, no analysis has been conducted to determine the possible changes in their choices of health professionals and its repercussions on their contraceptive use. METHODS: Our study is based on data from three population-based cross-sectional surveys conducted in 2010, 2013 and 2016 (Fecond 2010, Fecond 2013 and Baromètre Santé 2016) that collected information on women's contraceptive practices and the specialties of the health professionals having prescribed the methods they were using. RESULTS: Between 2010 and 2016, women went to a gynecologist or a midwife more often than to a general practitioner for prescription of a reversible contraceptive method. However, their changes in visiting prescribers did not explain the changes in their contraceptive practices observed over the period. In 2016, access to health professional remained largely dependent on women's socio-demographic characteristics: older ones and those from a more privileged social background or living in urban areas were more likely to consult a gynecologist for prescription of their contraceptive method. On the other hand, consultations of midwives for contraceptive prescription were more frequent among women with children and among those who relied on public health insurance alone. CONCLUSION: Following the "pill scare" that occurred in France in December 2012, the decision by some women to use the IUD instead of the pill led them to change health professionals, and also led practitioners to change their prescribing practices.


Assuntos
Anticoncepção/psicologia , Acesso aos Serviços de Saúde , Dispositivos Intrauterinos , Adolescente , Adulto , Atitude Frente a Saúde , Anticoncepção/métodos , Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Orais Hormonais/efeitos adversos , Estudos Transversais , Decepção , Feminino , França/epidemiologia , Ginecologia/ética , Ginecologia/estatística & dados numéricos , Ginecologia/tendências , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , História do Século XXI , Humanos , Meios de Comunicação de Massa/ética , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Visita a Consultório Médico/tendências , Opinião Pública , Comprimidos , Adulto Jovem
14.
Eur J Endocrinol ; 183(6): 619-626, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33105101

RESUMO

Objective: The use of combined hormonal contraceptives (CHCs) worsens glucose tolerance, but the risk for glucose metabolism disorders remains controversial. Design: The study is a prospective longitudinal population-based cohort study. Methods: The study was based on a cohort population that comprised 1879 women born in 1966. At age 46, the women answered a questionnaire on contraceptive use and underwent an oral glucose tolerance test. Glucose metabolism indices were evaluated in current CHC (n = 153), progestin-only contraceptive (POC, n = 842), and non-hormonal contraceptive users (n = 884). Results: In the entire study population, current CHC use was significantly associated with prediabetes (OR: 2.0, 95% CI: 1.3-3.2) and type 2 diabetes (OR: 3.3, 95% CI: 1.1-9.7) compared to non-hormonal contraceptive use. After 5 years of use, the prediabetes risk increased 2.2-fold (95% CI: 1.3-3.7) and type 2 diabetes risk increased 4.5-fold (95% CI: 1.5-13.5). Compared with the current POC use, current CHC use was significantly associated with prediabetes (OR: 1.9, 95% CI: 1.2-3.0). Current POC use was not associated with any glucose metabolism disorders. The results prevailed after adjusting for BMI and socioeconomic status. Conclusions: CHC use in perimenopausal women was associated with a significantly increased risk of glucose metabolism disorders. This association should be considered in women with increased metabolic risk.


Assuntos
Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Diabetes Mellitus Tipo 2/induzido quimicamente , Transtornos do Metabolismo de Glucose/induzido quimicamente , Estado Pré-Diabético/induzido quimicamente , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Perimenopausa , Estudos Prospectivos
16.
Expert Rev Clin Pharmacol ; 13(10): 1103-1123, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32903118

RESUMO

INTRODUCTION: The contraceptive activity of synthetic progestins is mediated through three basic mechanisms: (a) An anti-gonadotrophic action leading to the inhibition of ovulation; (b) Changes in cervical mucus characteristics that inhibit sperm penetration and (c) desynchronization of the endometrial picture necessary for implantation. AREAS COVERED: Mechanisms involved in the progestin-induced endometrium desynchronization are individually reviewed for each of the routes of administration and, whenever possible, by individual members of the various families of synthetic progestin derivatives. EXPERT OPINION: For contraceptive purposes, progestins are today administered through several routes: orally, as injections, subdermally and via the vagina or the uterine cavity. Given this variety of modalities, their effects may differ, depending on the route of administration, concentration reached at the level of the endometrium and the duration of use. These are characterized by inactivation of the endometrium. Progestin-only contraception provides a safe and effective control of fertility regulation, although, they are associated with the problem of endometrial break through bleeding that may lead to discontinuation. Unfortunately, in spite of a major research effort over two decades, there is not, as yet, an established long-term intervention available to manage bleeding irregularities, making mandatory a deeper understanding of the mechanisms involved is required.


Assuntos
Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Orais Hormonais/administração & dosagem , Progestinas/administração & dosagem , Animais , Anticoncepcionais Femininos/farmacologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/farmacologia , Endométrio/efeitos dos fármacos , Feminino , Humanos , Metrorragia/induzido quimicamente , Progestinas/efeitos adversos , Progestinas/farmacologia
17.
Eur J Neurol ; 27(12): 2625-2629, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32810878

RESUMO

BACKGROUND AND PURPOSE: There is a lack of comparative safety data on the risk of pseudotumor cerebri syndrome (PTCS) associated with different hormonal contraceptives. We sought to quantify the risk of PTCS associated with eight different types of hormonal contraceptives compared with oral levonorgestrel. METHODS: We conducted a retrospective cohort study, with a case-control analysis of 4 871 504 women aged 15-45 years in the period 2008-2015, using IQVIA Ambulatory Electronic Medical Records data in the USA. Patients who used nine different contraceptive agents including intrauterine levonorgestrel, medroxyprogesterone injection, etonogestrel/ethinyl estradiol vaginal ring and combination oral contraceptives (COCs) that contained ethinyl estradiol and the progestins levonorgestrel, norgestimate, desogestrel, norethindrone and drospirenone, were included. Diagnosis of PTCS was defined using the first International Classification of Diseases, 9th or 10th revision, code for intracranial hypertension in patients who had also received an imaging code in the 30 days prior to the index date. RESULTS: A total of 3323 PTCS cases and 13 292 matched controls were identified. No increase in risk was found when analysing intrauterine levonorgestrel or COCs containing desogestrel, norethindrone, drospirenone, norgestimate or norgestrel versus COC levonorgestrel. The adjusted incidence rate ratio for etonogestrel/etonogestrel/ethinyl estradiol vaginal ring and medroxyprogesterone suspension compared with levonorgestrel COC was 4.45 [95% confidence interval (CI) 1.98-9.96] and 2.20 (95% CI 1.33-3.64), respectively. CONCLUSIONS: This study found an elevated risk for PTCS among users of etonogestrel vaginal ring and medroxyprogesterone suspension when compared with oral levonorgestrel. Future studies are needed to confirm these findings.


Assuntos
Pseudotumor Cerebral , Adolescente , Adulto , Anticoncepcionais Orais Combinados , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Pessoa de Meia-Idade , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
18.
Curr Opin Hematol ; 27(5): 327-332, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32740039

RESUMO

PURPOSE OF REVIEW: Hormonal therapy is administered for multiple indications including contraception, alleviation of menopausal symptoms, hypogonadism, and more recently, gender-affirming care. Data suggest varying degrees of increased risk for venous thromboembolism (VTE). RECENT FINDINGS: While oral progestin only methods do not appear to increase the risk of VTE, an association was seen with injection progestin contraception. Combined oral contraception with low-dose ethinyl estradiol and most types of progestin increased the risk of VTE compared with levonorgestrel-containing oral therapies. While transdermal hormonal contraception has been previously associated with increased VTE, a recently approved levonorgestrel and ethinyl estradiol transdermal patch reported low rates (<0.2%) in a large single-arm open-label study. Women receiving postmenopausal HRT experienced an increased risk of VTE in a dose-dependent manner when using oral hormonal therapy while nonoral methods, such as topical estrogen, did not appear to increase the risk of VTE. Some studies suggest no increased risk of VTE with testosterone therapy, however, a recent case-crossover study suggested higher VTE risk in men on testosterone, particularly men less than age 65 without hypogonadism. Route of administration had no effect on VTE rates. The estimated incidence rate of VTE risk in transgender women receiving estrogen therapy is 2.3 per 1000 person years, but may be imprecise due to heterogeneity in studies included in published meta-analyses. Surgical risk estimates are primarily indirect data drawn from cisgender patients receiving hormone therapy in the perioperative setting. SUMMARY: Hormonal therapy affects VTE risk to varying degrees dependent on specific type of hormone, formulation, and occasionally route of delivery.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Tromboembolia Venosa/induzido quimicamente , Anticoncepcionais Orais Hormonais/farmacologia , Feminino , Humanos , Gravidez , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...