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1.
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
7.
Presse Med ; 48(11 Pt 1): 1269-1283, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31757732

RESUMO

Hypertension is a major risk factor for cardiovascular diseases. Because of the high frequency of hormonal contraceptives use, assessing their side effects is an important public health issue. In this perspective, we conducted a review of the risk of hypertension associated with the use of hormonal contraceptives, either combined estrogen-progestin or only progestin. The use of combined hormonal contraceptives, regardless of its type and route of administration, is associated with a slight increase in blood pressure, both systolic and diastolic blood pressures. The frequency of onset of hypertension in women who use combined hormonal contraception is between 0.6% and 8.5%. Progestin-only contraception seems safe with respect to the risk of hypertension. It is therefore important to remember that the use of combined hormonal contraception is contra-indicated in hypertensive women, even well controlled. Finally, we propose a prescription assistance algorithm according to the recommendations of an expert panel. It should be remembered that taking blood pressure at each contraceptive consultation (initial and follow-up) is essential.


Assuntos
Anticoncepção/efeitos adversos , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Hipertensão/induzido quimicamente , Progestinas/efeitos adversos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Humanos , Pessoa de Meia-Idade , Progestinas/administração & dosagem , Fatores de Risco , Adulto Jovem
8.
Blood ; 134(26): 2346-2353, 2019 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-31697819

RESUMO

Genetic predispositions to venous thromboembolism (VTE) are relatively frequent in the general population and comprise a heterogeneous group of disorders. Whereas the most frequent congenital risk factors for thrombosis only moderately increase the risk, a deficiency in antithrombin (AT), one of the most important natural inhibitors of blood coagulation, carries a higher risk. Congenital AT deficiency is an infrequently encountered genetic risk factor for VTE, and different subtypes vary with regard to their thrombotic risk. Patients with congenital AT deficiency, especially those with quantitative deficiency (type 1), may develop thrombosis early in life and often have a conspicuous family history of first- and second-degree relatives with VTE. Women are particularly affected because of the risk potentiation by combined estrogen/progestogen oral contraceptive use or pregnancy. The lack of controlled trials or even observational studies of large cohorts does not allow therapeutic decisions to be based on scientific evidence. In this review, we will discuss cases with thrombotic manifestations and the tailored management of patients with this congenital thrombosis risk factor.


Assuntos
Anticoagulantes/uso terapêutico , Deficiência de Antitrombina III/complicações , Antitrombinas/uso terapêutico , Anticoncepcionais Orais Hormonais/efeitos adversos , Trombose/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Adolescente , Adulto , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Gravidez , Prognóstico , Fatores de Risco , Trombose/induzido quimicamente , Tromboembolia Venosa/induzido quimicamente , Adulto Jovem
9.
Endocrinol Metab Clin North Am ; 48(4): 859-873, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31655781

RESUMO

Untoward side effects of pharmaceuticals can result in considerable morbidity and expense to the health care system. There is likely a sizable fraction of the hypertensive population with disease either induced or exacerbated by polypharmacy. The elevation of blood pressure in drug-induced hypertension occurs through a variety of mechanisms, most notably, sodium and fluid retention, activation of the renin-angiotensin-aldosterone system, alteration of vascular tone, or a combination of these pathways. Recognition of common medications causing drug-induced hypertension is important to effectively control blood pressure. The epidemiology, pathophysiology, and management of these agents are discussed.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Inibidores de Calcineurina/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Glucocorticoides/efeitos adversos , Hematínicos/efeitos adversos , Hipertensão/induzido quimicamente , Hipertensão/terapia , Polimedicação , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Humanos
10.
J Med Case Rep ; 13(1): 314, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31639046

RESUMO

BACKGROUND: To determine the prevalence of and risk factors for malignant transformation of ovarian endometrioma during dienogest therapy, which is very rare, we examined multiple cases of malignant transformation of ovarian endometrioma during dienogest therapy and performed a multivariate analysis of the records in our hospital. METHODS: The medical records of 174 patients who underwent DNGT for the treatment of OMA from June 1, 2011, to May 31, 2018, were reviewed retrospectively with the approval of the Human Ethical Committee of the University of Teikyo Hospital. And we provided one representative case of MT with obtaining written informed consent. To assess the effects of six representative factors, including advanced age, parity, surgical history, and endometrial cyst characteristics (including 3 factors), on the possibility of malignant transformation, we performed a multivariate logistic regression analysis. RESULTS: Of the 174 cases, 4 were diagnosed with malignant transformation, and these cases are reported. In the multivariate analysis, advanced age (P = 0.0064), nullipara (P = 0.0322), and enlargement (P = 0.0079) showed significant differences for malignant transformation occurrence. All 4 malignant transformation cases were among the 19 patients who had all of these 3 factors. CONCLUSIONS: For a more accurate determination of the treatment approach, a larger sample size will be needed to determine the risk factors for malignant transformation during dienogest therapy.


Assuntos
Transformação Celular Neoplásica , Anticoncepcionais Orais Hormonais/efeitos adversos , Endometriose/patologia , Nandrolona/análogos & derivados , Doenças Ovarianas/patologia , Neoplasias Ovarianas/patologia , Adenocarcinoma de Células Claras/patologia , Adulto , Fatores Etários , Endometriose/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Nandrolona/efeitos adversos , Doenças Ovarianas/tratamento farmacológico , Paridade , Estudos Retrospectivos , Fatores de Risco
13.
Obstet Gynecol ; 134(3): 573-580, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31403592

RESUMO

OBJECTIVE: To examine the relationship between hormonal contraception and vaginal infections with bacterial vaginosis, vaginal candidiasis, or trichomoniasis. METHODS: Couples who were human immunodeficiency virus (HIV) serodiscordant in Zambia were enrolled in a longitudinal cohort study. From 1994 to 2002, both partners were seen quarterly and received physical exams including genital examinations. Separate rates for three outcome infections of interest (bacterial vaginosis, vaginal candidiasis, and trichomoniasis) were calculated. Bivariate associations between baseline and time-varying covariates and outcome infections of interest were evaluated using unadjusted Anderson-Gill survival models. Adjusted hazard ratios (aHRs) were generated using multivariable Anderson-Gill survival models that included demographic and clinical factors associated with both hormonal contraceptive use and each infection of interest. RESULTS: There were 1,558 cases of bacterial vaginosis, 1,529 cases of vaginal candidiasis, and 574 cases of trichomoniasis over 2,143 person-years of observation. Depot medroxyprogesterone acetate (DMPA) users had significantly lower rates of trichomoniasis and bacterial vaginosis. In adjusted models, DMPA was protective for bacterial vaginosis (aHR=0.72; 95% CI 0.54-0.95), candidiasis (aHR 0.75, 95% CI 0.57-1.00) and trichomoniasis (aHR=0.43, 95% CI 0.25-0.74). Oral contraceptive pills were protective for candidiasis (aHR=0.79, 95% CI 0.65-0.97). CONCLUSION: We confirm that DMPA use was associated with reduced rates of the three most common causes of vaginitis, and oral contraceptive pill use was associated with reduced rates of candidiasis among women in couples who were HIV discordant.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Soropositividade para HIV/microbiologia , Contracepção Hormonal/efeitos adversos , Vaginite/induzido quimicamente , Adulto , Candidíase Vulvovaginal/induzido quimicamente , Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/virologia , Feminino , Soronegatividade para HIV , Humanos , Masculino , Acetato de Medroxiprogesterona/efeitos adversos , Parceiros Sexuais , Vaginite por Trichomonas/induzido quimicamente , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/virologia , Vaginite/epidemiologia , Vaginite/virologia , Vaginose Bacteriana/induzido quimicamente , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/virologia , Zâmbia/epidemiologia
14.
J Stroke Cerebrovasc Dis ; 28(10): 104247, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350167

RESUMO

BACKGROUND/OBJECTIVE: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. METHODS: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT. RESULTS: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT. CONCLUSIONS: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.


Assuntos
Trombose Intracraniana/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Anemia/epidemiologia , Ásia/epidemiologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/mortalidade , Trombose Intracraniana/terapia , Masculino , Gravidez , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Trombofilia/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade , Trombose Venosa/terapia , Adulto Jovem
16.
Curr Psychiatry Rep ; 21(7): 57, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31172309

RESUMO

PURPOSE OF REVIEW: We examine recent studies that investigate the effects of hormonal contraception on mood in different populations of women, including women in the general population and women with diagnosed psychiatric and gynecologic disorders. We address the mechanisms of several types of hormonal contraceptives and assess how these may affect mood and gynecologic disorders. RECENT FINDINGS: The effects of hormonal contraceptives seem to be most relevant in selected subsets of women, as they may promote improved mental health in particular psychiatric disorders such as PMDD. Currently, there is no consistent evidence for negative effects of most hormonal contraceptives in the general population. Even though some studies reveal that certain individuals appear susceptible to negative mood effects from some forms of hormonal contraceptives, more research is needed to better identify these susceptible individuals.


Assuntos
Afeto/efeitos dos fármacos , Transtornos de Ansiedade/induzido quimicamente , Anticoncepcionais Orais Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/farmacologia , Transtorno Depressivo/induzido quimicamente , Transtornos de Ansiedade/psicologia , Anticoncepcionais Orais Hormonais/administração & dosagem , Transtorno Depressivo/psicologia , Feminino , Humanos , Transtornos Mentais
17.
Sports Med ; 49(11): 1637-1650, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31190324

RESUMO

Resistance training is essential for health and performance and confers many benefits such as increasing skeletal muscle mass, increasing strength and power output, and improving metabolic health. Resistance training is a major component of the physical activity guidelines, yet research in female populations is limited. Recent increases in the promotion of, and the participation by, females in sport and exercise, highlight the need for an increase in understanding of evidence-based best practice exercise prescription for females. The aim of this review is to provide an overview of the current research regarding resistance training performance and skeletal muscle adaptation in females, with a focus on the hormonal variables that may influence resistance training outcomes. Findings suggest that the menstrual cycle phase may impact strength, but not skeletal muscle protein metabolism. In comparison, oral contraception use in females may reduce skeletal muscle protein synthesis, but not strength outcomes, when compared to non-users. Future research should investigate the role of resistance training in the maintenance of skeletal muscle protein metabolism during pregnancy, menopause and in athletes experiencing relative energy deficiency in sport. The review concludes with recommendations for researchers to assist them in the inclusion of female participants in resistance training research specifically, with commentary on the most appropriate methods of controlling for, or understanding the implications of, hormonal fluctuations. For practitioners, the current evidence suggests possible resistance training practices that could optimise performance outcomes in females, although further research is warranted.


Assuntos
Proteínas Musculares/metabolismo , Músculo Esquelético/metabolismo , Treinamento de Resistência , Adaptação Fisiológica , Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Hormônios Esteroides Gonadais/fisiologia , Humanos , Ciclo Menstrual , Força Muscular , Fatores Sexuais
18.
Matern Child Health J ; 23(8): 1079-1086, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31069600

RESUMO

OBJECTIVES: Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. METHODS: Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum. RESULTS: Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. CONCLUSIONS FOR PRACTICE: A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.


Assuntos
Aleitamento Materno/psicologia , Anticoncepcionais Orais Hormonais/normas , Pessoal de Saúde/psicologia , Adulto , Atitude do Pessoal de Saúde , Anticoncepcionais Orais Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/uso terapêutico , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/normas , Serviços de Planejamento Familiar/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/normas , Inquéritos e Questionários
19.
Eur J Contracept Reprod Health Care ; 24(3): 192-197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31112059

RESUMO

Purpose: This study aimed to explore the prescription of different contraceptive methods to Swedish women with obesity and to compare the pattern of prescription and adherence to treatment between this group and normal-weight women. Materials and methods: This study included 371 women with obesity and 744 matched normal-weight women, aged 18-40. Medical records were scrutinised for the period 1 January 2010 to 31 December 2014. The retrieved variables included: background characteristics, prescribed contraceptive methods, adverse effects, duration of treatment, reason for discontinuation and bleeding pattern. Result: Progestin-only pills were mainly prescribed to women with obesity (44% vs. 20%, p = 0.001) whereas combined hormonal contraception was mainly prescribed to normal-weight women (60% vs. 21%, p < 0.0001). Thirty-three percent vs. 25% (p = 0.003) discontinued their contraceptive method within 1 year. The most commonly declared reason for discontinuation was bleeding disturbance (14.7% vs. 9.6%, p = 0.008). Conclusion: The most commonly prescribed contraceptive method in women with obesity was progestin-only pills, but surprisingly many women with obesity were prescribed combined hormonal contraception despite current Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within the first year of the study period, compared with incident normal-weight users.


Assuntos
Anticoncepcionais Orais Combinados , Anticoncepcionais Orais Hormonais , Prescrições de Medicamentos/estatística & dados numéricos , Peso Corporal Ideal , Adesão à Medicação/estatística & dados numéricos , Obesidade , Adolescente , Adulto , Anticoncepção/métodos , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Humanos , Dispositivos Intrauterinos de Cobre/estatística & dados numéricos , Acetato de Medroxiprogesterona , Distúrbios Menstruais/induzido quimicamente , Obesidade/complicações , Guias de Prática Clínica como Assunto , Progestinas/efeitos adversos , Estudos Retrospectivos , Suécia , Adulto Jovem
20.
Crit Rev Oncol Hematol ; 137: 123-130, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31014508

RESUMO

The possibility that the use of hormonal contraceptives may increase the risk of breast cancer has been raised since many years. In the past this hypothesis has been dismissed on the basis that available data were generally derived from "old" studies in which relatively high hormone doses had been used. The recent publication of two studies that analysed data from women receiving low-dose hormonal contraception and showed a statistically significant increase in breast cancer contradicts this reassuring belief. The topic however is not settled, since different results were obtained in other studies and since hormonal contraception (HC) also has unquestionable positive effects such as a decrease in ovarian and in endometrial cancer. The aim of the present paper is to provide evidence that may help gynaecologists and oncologists in discussing with their patients the use of HC. Even if cancer phobia is a strong reason for not using or limiting HC, patients must be informed that notwithstanding the slightly increased breast cancer risk, the overall cancer risk may still be lower than non-users. Proper counselling may help the woman choose the most suitable contraception in the different phases of her life and on the basis of other conditions that may increase cancer risk such as overweight, smoking or family history.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Orais/administração & dosagem , Aconselhamento/métodos , Neoplasias da Mama/induzido quimicamente , Neoplasias da Mama/psicologia , Anticoncepcionais Orais/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Estilo de Vida Saudável , Humanos , Risco
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