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1.
Obstet Gynecol ; 136(5): 1047-1058, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33030880

RESUMO

Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Dismenorreia/diagnóstico , Dismenorreia/terapia , Dismenorreia/metabolismo , Feminino , Humanos , Prostaglandinas/biossíntese
2.
Endocrinology ; 161(9)2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32730568

RESUMO

Severe outcomes and death from the novel coronavirus disease 2019 (COVID-19) appear to be characterized by an exaggerated immune response with hypercytokinemia leading to inflammatory infiltration of the lungs and acute respiratory distress syndrome. Risk of severe COVID-19 outcomes is consistently lower in women than men worldwide, suggesting that female biological sex is instrumental in protection. This mini-review discusses the immunomodulatory and anti-inflammatory actions of high physiological concentrations of the steroids 17ß-estradiol (E2) and progesterone (P4). We review how E2 and P4 favor a state of decreased innate immune inflammatory response while enhancing immune tolerance and antibody production. We discuss how the combination of E2 and P4 may improve the immune dysregulation that leads to the COVID-19 cytokine storm. It is intended to stimulate novel consideration of the biological forces that are protective in women compared to men, and to therapeutically harness these factors to mitigate COVID-19 morbidity and mortality.


Assuntos
Infecções por Coronavirus/imunologia , Estradiol/imunologia , Imunomodulação/imunologia , Pneumonia Viral/imunologia , Progesterona/imunologia , Formação de Anticorpos/imunologia , Betacoronavirus , Anticoncepcionais Orais Hormonais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Síndrome da Liberação de Citocina/imunologia , Reposicionamento de Medicamentos , Estradiol/uso terapêutico , Terapia de Reposição de Estrogênios , Estrogênios/uso terapêutico , Feminino , Humanos , Tolerância Imunológica/imunologia , Imunidade Inata/imunologia , Masculino , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Índice de Gravidade de Doença , Fatores Sexuais
3.
Cochrane Database Syst Rev ; 7: CD013651, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32700364

RESUMO

BACKGROUND: Within the context of heavy menstrual bleeding, pandemics impact upon women's assessment and treatment by healthcare providers. OBJECTIVES: To summarise the evidence from Cochrane Reviews evaluating interventions for heavy menstrual bleeding that are commonly available during pandemics. METHODS: We sought published Cochrane Reviews, evaluating interventions that can continue during pandemics for women with heavy menstrual bleeding with no known underlying cause. We identified Cochrane Reviews by searching the Cochrane Database of Systematic Reviews in June 2020. The primary outcome was menstrual bleeding. Secondary outcomes included quality of life, patient satisfaction, side effects, and serious adverse events. We undertook the selection of systematic reviews, data extraction, and quality assessment in duplicate. We resolved any disagreements by discussion. We assessed review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool, and the certainty of the evidence for each outcome using GRADE methods. MAIN RESULTS: We included four Cochrane Reviews, with 11 comparisons, data from 44 randomised controlled trials (RCTs), and 3196 women. We assessed all the reviews to be high quality. Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be more effective in reducing heavy menstrual bleeding than placebo (mean difference (MD) -124 mL per cycle, 95% confidence interval (CI) -186 to -62 mL per cycle; 1 RCT, 11 women; low-certainty evidence). Mefenamic acid may be similar to naproxen (MD 21 mL per cycle, 95% CI -6 to 48 mL per cycle; 2 RCTs, 61 women; low-certainty evidence), and NSAIDs may be similar to combined hormonal contraceptives for heavy menstrual bleeding (MD 25 mL per cycle, 95% CI -22 to 73 mL per cycle; 1 RCT, 26 women; low-certainty evidence). NSAIDs may be be less effective in reducing menstrual bleeding than antifibrinolytics (relative risk (RR) 0.70, 95% CI 0.58 to 0.85; 2 RCTs, 161 women; low-certainty evidence). We are uncertain whether NSAIDs reduce menstrual blood loss more than short-cycle progestogens (RR 0.80, 95% CI 0.49 to 1.32; 1 RCT 32 women; very low-certainty evidence). Antifibrinolytics Antifibrinolytics appear to be more effective in reducing heavy menstrual bleeding than placebo (MD -53 mL per cycle, 95% CI -63 to -44 mL per cycle; 4 RCTs, 565 women; moderate-certainty evidence). Antifibrinolytics may be similar to placebo on the incidence of side effects (RR 1.05, 95% CI 0.93 to 1.18; 1 RCT, 297 women; low-certainty evidence), and they are probably similar on the incidence of serious adverse events (thrombotic events; RR 0.10, 95% CI 0.00 to 2.46; 2 RCT, 468 women; moderate-certainty evidence). Antifibrinolytics may be more effective in reducing heavy menstrual bleeding than short-cycle progestogen (MD -111 mL per cycle, 95% CI -178 mL to -44 mL per cycle; 1 RCT, 46 women; low-certainty evidence). We are uncertain whether antifibrinolytics are similar to short-cycle progestogens on quality of life (RR 1.67, 95% CI 0.76 to 3.64; 1 RCT, 44 women; very low-certainty evidence), patient satisfaction (RR 0.91, 95% CI 0.59 to 1.39; 1 RCT, 42 women; very low-certainty evidence), or side effects (RR 0.85, 95% CI 0.65 to 1.12; 3 RCTs, 211 women; very low-certainty evidence). We are uncertain whether antifibrinolytics are more effective in reducing heavy menstrual bleeding when compared with long-cycle progestogen (MD -9 points per cycle, 95% CI -30 to 12 points per cycle; 2 RCTs, 184 women; low-certainty evidence). Antifibrinolytics may increase self-reported improvement in menstrual bleeding when compared with long-cycle medroxyprogesterone acetate (RR 1.32, 95% CI 1.08 to 1.61; 1 RCT, 94 women; low-certainty evidence). Antifibrinolytics may be similar to long-cycle progestogens on quality of life (MD 5, 95% CI -2.49 to 12.49; 1 RCT, 90 women; low-certainty evidence). We are uncertain whether antifibrinolytics are similar to long-cycle progestogens on side effects (RR 0.58, 95% CI 0.33 to 1.00; 2 RCTs, 184 women; very low-certainty evidence). There were no trials comparing antifibrinolytics to combined hormonal contraceptives. Combined hormonal contraceptives Combined hormonal contraceptives appear to be more effective for heavy menstrual bleeding than placebo or no treatment (RR 13.25, 95% CI 2.94 to 59.64; 2 RCTs, 363 women; moderate-certainty evidence). Combined hormonal contraceptives are probably similar to placebo on the incidence of side effects (RR 1.53, 95% CI 0.90 to 2.60; 2 RCTs, 411 women; moderate-certainty evidence). Progestogens There were no trials comparing progestogens to placebo. Limitations in the evidence included risk of bias in the primary RCTs, inconsistency between the primary RCTs, and imprecision in effect estimates. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that antifibrinolytics and combined hormonal contraceptives reduce heavy menstrual bleeding compared with placebo. There is low-certainty evidence that NSAIDs reduce heavy menstrual bleeding compared with placebo. There is low-certainty evidence that antifibrinolytics are more effective in reducing heavy menstrual bleeding when compared with NSAIDs and short-cycle progestogens, but we are unable to draw conclusions about the effects of antifibrinolytics compared to long-cycle progestogens, on low-certainty evidence.


Assuntos
Menorragia/tratamento farmacológico , Pandemias , Anti-Inflamatórios não Esteroides/uso terapêutico , Antifibrinolíticos/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Humanos , Ácido Mefenâmico/uso terapêutico , Placebos/uso terapêutico , Progestinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Literatura de Revisão como Assunto
4.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(5): 351-356, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199350

RESUMO

Los anticonceptivos orales son fármacos compuestos por un estrógeno y un progestágeno, habitualmente sintéticos, que inhiben la ovulación. En dermatología los anticonceptivos orales se emplean con 2 indicaciones principales: para evitar el embarazo cuando empleamos fármacos teratógenos y para tratar manifestaciones cutáneas de hiperandrogenismo. La mayoría de los anticonceptivos orales mejoran tanto el acné como el hirsutismo, sin embargo el empleo exclusivo de progestágenos como anticonceptivos, especialmente de primera o segunda generación puede agravar o desencadenar un acné, debido a su efecto androgénico. La trombosis es uno de los efectos secundarios más graves de los anticonceptivos orales y depende sobre todo de los estrógenos empleados y su dosis. Si atendemos solo al perfil trombótico, el anticonceptivo oral de elección debería ser el que combinara 30 o menos mig de etinilestradiol con el levonorgestrel. Por el contrario, si lo que queremos es tratar signos de androgenización, los anticonceptivos orales preferidos serán aquellos con progestágenos de efecto antiandrogénico


Oral contraceptives combine estrogen and progesterone to suppress ovulation. Synthetic forms are usually used. In dermatology, oral contraceptives are prescribed for 2 main reasons: to prevent pregnancy when teratogenic drugs must be taken and to treat skin manifestations of hyperandrogenism. Most oral contraceptives improve both acne and hirsutism, but the androgenic effect of progestogens - particularly if the contraceptive contains first- or second-generation progestogens- can trigger or exacerbate acne. One of the most serious side effects of oral contraceptives, thrombosis, is mainly caused by the estrogen component and its dose. If we mainly consider a contraceptive's thrombotic profile when prescribing, the choice would be to have 30 Mug or less of ethinyl estradiol combined with levonorgestrel. On the other hand, if our main objective is to treat signs of androgenization, we would prefer contraceptives containing progestogens with antiandrogenic effects


Assuntos
Humanos , Anticoncepcionais Orais Hormonais/uso terapêutico , Hiperandrogenismo/tratamento farmacológico , Acne Vulgar/tratamento farmacológico , Hirsutismo/tratamento farmacológico
7.
J Womens Health (Larchmt) ; 29(7): 937-943, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32155101

RESUMO

Contraceptives that contain estrogen and/or progestins are used by millions of women around the world to prevent pregnancy. Owing to their unique physiological mechanism of action, many of these medications can also be used to prevent cancer and treat multiple general medical conditions that are common in women. We performed a comprehensive literature search. This article will describe the specific mechanisms of action and summarize the available data documenting how hormonal contraceptives can prevent ovarian and uterine cancer and be used to treat women with a variety of gynecological and nongynecological conditions such as endometriosis, uterine fibroids, heavy menstrual bleeding, polycystic ovary syndrome, acne, and migraines. Contraceptive methods containing estrogen and progestin can be used for a wide variety of medical issues in women.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Endometriose/tratamento farmacológico , Estrogênios/uso terapêutico , Neoplasias Ovarianas/prevenção & controle , Síndrome do Ovário Policístico/tratamento farmacológico , Progestinas/uso terapêutico , Neoplasias Uterinas/prevenção & controle , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Saúde Reprodutiva
10.
Horm Behav ; 119: 104652, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31812533

RESUMO

A growing body of research suggests that hormonal contraceptive (HC) use may be associated with lower self-control, as well as structural and functional differences in women's brains that could contribute to differences in perseverance on tasks requiring cognitive control. Here, we sought to extend this research by examining the relationship between HC use and college-aged women's perseverance (i.e., time spent) and performance on tasks requiring cognitive control. Across two studies, we find that, compared to naturally-cycling women, women using HCs display less perseverance on both simple (i.e., a spot-the-difference game) and challenging (i.e., Graduate Record Examination quantitative problems) tasks. Moreover, these differences in perseverance were found to predict performance decrements across tasks, with women taking HCs performing worse because they spent less time on the tasks. By demonstrating how HC use may influence perseverance and thereby performance, these results contribute to a growing body of research examining the unintended implications of HC use on cognition, learning, and memory.


Assuntos
Adaptação Psicológica/efeitos dos fármacos , Cognição/efeitos dos fármacos , Anticoncepcionais Orais Hormonais/uso terapêutico , Função Executiva/efeitos dos fármacos , Resiliência Psicológica/efeitos dos fármacos , Adulto , Encéfalo/efeitos dos fármacos , Encéfalo/fisiologia , Cognição/fisiologia , Feminino , Humanos , Resolução de Problemas/efeitos dos fármacos , Psicometria , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Autoimagem , Autocontrole/psicologia , Adulto Jovem
11.
Int J Impot Res ; 32(2): 239-247, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31263248

RESUMO

The effect of nomegestrol acetate/estradiol (NOMAC/E2) on clitoral and uterine vascularization has never been evaluated. We aimed to investigate, in women consulting for contraceptive needs, the possible changes in clitoral and uterine arteries hemodynamic parameters after 6 months treatment with NOMAC/E2 as compared with other hormonal contraceptives (HCs). In this observational, prospective pilot study, ten women were enrolled. Color Doppler ultrasound was performed on the clitoral and uterine arteries at baseline and after 6 months treatment with NOMAC/E2 (n = 5) or other HCs (n = 5). NOMAC/E2 did not exert any significant effect on clitoral vascular resistance expressed by the pulsatility index (PI); conversely, treatment with other HCs significantly increased this parameter (p = 0.04). The change in clitoral PI between the two groups retained a statistically significant difference even after adjusting for age. In the NOMAC/E2 group, at follow-up, uterine artery PI and acceleration were significantly reduced (p = 0.04), whereas no significant differences were observed in the HCs group; however, the change in uterine artery parameters did not differ significantly between the two groups. NOMAC/E2, differently from other COCs, does not negatively alter the vascular resistance of clitoral arteries and appears as a good contraceptive choice to protect both cardiovascular and sexual health.


Assuntos
Clitóris/irrigação sanguínea , Estradiol/uso terapêutico , Megestrol/uso terapêutico , Norpregnadienos/uso terapêutico , Resistência Vascular , Adulto , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Humanos , Itália , Modelos Lineares , Projetos Piloto , Estudos Prospectivos , Ultrassonografia Doppler em Cores , Artéria Uterina/diagnóstico por imagem , Adulto Jovem
13.
Eur J Obstet Gynecol Reprod Biol ; 243: 125-132, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31693949

RESUMO

Polycystic ovary syndrome (PCOS) risk factors overlap with breast cancer, and the hormonal profile may be implicated in breast cancer pathogenesis. This study aims to report a literature review considering epidemiological and molecular mechanisms that correlate PCOS and breast cancer, as well as the influence of PCOS treatment on the incidence of breast cancer. Epidemiological studies failed to adjust potential variables that affect the risk and have thus provided inconclusive results. Molecular effects of androgenic pathways in breast cancer have been studied and androgens seem to have an inhibitory effect on mammary epithelial proliferation. However, increased bioavailable androgens were associated with recurrence of breast cancer due to conversion to oestrogens. Sex hormone-binding globulin has a role in hormone-dependent cancers and can be considered a marker for PCOS; a gene profile has already been linked to breast cancer risk in these patients. PCOS medical treatment is a promising tool for stratifying breast cancer risk due to the metabolic influence and hormonal environment. Clinical reports are inconsistent, emphasizing the need for further studies with a prospective design. In the future, the role of pharmacological interventions in PCOS will increase knowledge and awareness of breast cancer pathogenesis and will help to refine breast cancer risk stratification.


Assuntos
Neoplasias da Mama/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Androgênios/metabolismo , Anovulação/tratamento farmacológico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/metabolismo , Clomifeno/uso terapêutico , Anticoncepcionais Orais Combinados/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Estrogênios/metabolismo , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Humanos , Hiperandrogenismo/epidemiologia , Hiperandrogenismo/metabolismo , Hipoglicemiantes/uso terapêutico , Letrozol/uso terapêutico , Metformina/uso terapêutico , Indução da Ovulação , Síndrome do Ovário Policístico/tratamento farmacológico , Síndrome do Ovário Policístico/metabolismo , Fatores de Risco , Globulina de Ligação a Hormônio Sexual/metabolismo
14.
Perspect Biol Med ; 62(3): 503-518, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31495794

RESUMO

This essay analyzes the conflicts that arise between an individual's deeply held beliefs and the collective norms of society. Sometimes these conflicts are framed in religious terms. The author argues that such a framing is too narrow and inappropriately puts the focus on a specific set of (largely Christian) beliefs about matters related to sexuality. This essay attempts to broaden the discussion in order to highlight the ways in which conflicts between individual beliefs and practices, on the one hand, and prevailing societal norms, on the other, create the tension that can lead to societal change.


Assuntos
Recusa Consciente em Tratar-se , Cultura , Relações Médico-Paciente/ética , Normas Sociais , Aborto Induzido/ética , Cristianismo , Recusa Consciente em Tratar-se/ética , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Futebol Americano , Humanos , Imunização/ética , Obrigações Morais , Médicos , Gravidez , Obtenção de Tecidos e Órgãos/ética , Estados Unidos
16.
Am Fam Physician ; 100(3): 168-175, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31361105

RESUMO

Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. Less common causes include idiopathic hirsutism, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, medications, hyperprolactinemia, thyroid disorders, and Cushing syndrome. Women with an abnormal hirsutism score based on the Ferriman-Gallwey scoring system should be evaluated for elevated androgen levels. Women with rapid onset of hirsutism over a few months or signs of virilization are at high risk of having an androgen-secreting tumor. Hirsutism may be treated with pharmacologic agents and/or hair removal. Recommended pharmacologic therapies include combined oral contraceptives, finasteride, spironolactone, and topical eflornithine. Because of the length of the hair growth cycle, therapies should be tried for at least six months before switching treatments. Hair removal methods such as shaving, waxing, and plucking may be effective, but their effects are temporary. Photoepilation and electrolysis are somewhat effective for long-term hair removal but are expensive.


Assuntos
Hiperplasia Suprarrenal Congênita/complicações , Síndrome de Cushing/complicações , Hirsutismo/etiologia , Hiperandrogenismo/complicações , Hiperprolactinemia/complicações , Neoplasias/complicações , Síndrome do Ovário Policístico/complicações , Doenças da Glândula Tireoide/complicações , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/terapia , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Eflornitina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Remoção de Cabelo , Hirsutismo/diagnóstico , Hirsutismo/terapia , Humanos , Hiperandrogenismo/diagnóstico , Hiperandrogenismo/terapia , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/terapia , Leuprolida/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Neoplasias/diagnóstico , Neoplasias/terapia , Inibidores da Ornitina Descarboxilase/uso terapêutico , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/terapia , Espironolactona/uso terapêutico , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia
17.
J Pediatr Adolesc Gynecol ; 32(5): 535-540, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31181330

RESUMO

STUDY OBJECTIVE: The aim of this study was to review the efficacy of different medical modalities for menstrual suppression in the cohort of patients with disabilities who presented to the Queensland Paediatric and Adolescent Gynaecology (PAG) Service between January 2005 and December 2015. Menstrual suppression in adolescents with disabilities is an important aspect of care to support the patient and their carers in managing the complexities of menstrual hygiene, pain, and other discomfort associated with menses. It is important for general practitioners, pediatricians, and gynecologists to establish the right modality of suppression for each individual adolescent. DESIGN, SETTINGS, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The study was a retrospective case notes review of 68 adolescents who presented to the Queensland PAG Service, Brisbane, Australia with a request for menstrual suppression. The medical interventions included treatment with either combined oral hormonal contraceptive, oral medroxyprogesterone, depot medroxyprogesterone, or the levonorgestrel intrauterine system (Mirena, Bayer). The primary outcome measure was success of menstrual suppression from commencement of medical intervention to achievement of complete amenorrhea or very light bleeding described as spotting, for each medical modality. Secondary outcomes were length of time from first treatment to first observed menstrual suppression, and the number of outpatient appointments taken to achieve menstrual suppression. RESULTS: Of the 68 adolescents, 59/68 (86.8%) successfully achieved menstrual suppression, with 9/68 (13.2%) having ongoing treatment or loss to follow-up at the time of conclusion of the study; 39/68 (57.4%) were menstrually suppressed with their chosen medical modality after their initial appointment. CONCLUSION: Medical modalities are highly effective in achieving menstrual suppression and no young women at this institution required a hysterectomy. Depot medroxyprogesterone was the most successful modality used to achieve menstrual suppression followed by the levonorgestrel intrauterine system. The combined oral hormonal contraceptive was the least successful medical treatment in achieving menstrual suppression.


Assuntos
Amenorreia/induzido quimicamente , Anticoncepcionais Orais Hormonais/uso terapêutico , Pessoas com Deficiência , Levanogestrel/uso terapêutico , Menstruação/efeitos dos fármacos , Adolescente , Austrália , Criança , Anticoncepcionais Orais Hormonais/farmacologia , Feminino , Humanos , Levanogestrel/farmacocinética , Estudos Retrospectivos , Adulto Jovem
18.
Eur J Cancer ; 116: 199-206, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31212162

RESUMO

Li-Fraumeni syndrome (LFS) is a rare autosomal dominant cancer predisposition syndrome with exceptionally high lifetime cancer risks, caused primarily by germline TP53 variants. Early-onset breast cancer is the most common cancer in women with LFS. Associations between female reproductive factors and breast cancer risk have been widely studied in the general population and BRCA1/2 mutation carriers but not in LFS. We evaluated whether reproductive factors are associated with breast cancer in LFS. Questionnaire data were collected for 152 women with confirmed germline TP53 variants enrolled in the National Cancer Institute's LFS study (NCT01443468); of which, 85 had breast cancer, confirmed by pathology/medical reports. Fisher's exact test and Cox proportional hazards were used to calculate the effect of reproductive factors on breast cancer risk. Lifetime breastfeeding for at least 7 months was associated with lower breast cancer risk (hazard ratio [HR] 0.57, p = 0.05). Parity did not independently change breast cancer risk (HR 1.08, p = 0.8) but suggested an increased risk with older age at first live birth (HR 2.14, p = 0.05). Age at menarche (HR 1.09, p = 0.24) and use of oral contraceptives (HR 0.88; p = 0.7) did not significantly affect breast cancer risk. In this first study of reproductive factors and breast cancer in women with LFS, breastfeeding was observed to be protective against breast cancer risk, especially with at least 7 months of lifetime breastfeeding. Older age at first live birth was suggested to slightly increase breast cancer risk. Larger prospective studies of reproductive factors are warranted in women with LFS before making definitive clinical recommendations.


Assuntos
Neoplasias da Mama/etiologia , Síndrome de Li-Fraumeni/complicações , Adulto , Aleitamento Materno , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Humanos , Menarca/fisiologia , Pessoa de Meia-Idade , Paridade/fisiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Clin Pharmacol Ther ; 106(6): 1338-1345, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31206615

RESUMO

The association between estrogen-containing oral contraceptives and history of pregnancies with disease severity in women with polycystic liver disease (PLD) is unclear. We performed a cross-sectional cohort study to assess this association by selecting female patients with PLD of which imaging was available prior to any liver volume-reducing therapy. Patients received a questionnaire to collect detailed information on estrogen use and pregnancies. Preplanned subgroup analyses were performed on premenopausal and postmenopausal patients. The questionnaire was returned by 287 of 360 selected patients (80%). There was no significant association between estrogen-containing oral contraceptives and height-adjusted total liver volume (hTLV) in the total group (P = 0.06) and postmenopausal subgroup (P = 0.7). By contrast, each year of exposure corresponds with a 1.45% higher hTLV (P = 0.02) in the premenopausal subgroup, equivalent to a 15.5% higher hTLV for every 10 years of use. Pregnancy duration was not associated with hTLV. In conclusion, patients with PLD should avoid exogenous estrogens.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Cistos/patologia , Estrogênios/uso terapêutico , Hepatomegalia/patologia , Hepatopatias/patologia , Fígado/patologia , Adulto , Aleitamento Materno , Cistos/complicações , Feminino , Número de Gestações , Humanos , Hepatopatias/complicações , Menarca , Pessoa de Meia-Idade , Tamanho do Órgão , Rim Policístico Autossômico Dominante/complicações , Pós-Menopausa , Pré-Menopausa , Progestinas/uso terapêutico , História Reprodutiva , Fatores de Risco , Índice de Gravidade de Doença
20.
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
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