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3.
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
4.
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
5.
Eur J Obstet Gynecol Reprod Biol ; 238: 120-124, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132690

RESUMO

OBJECTIVE: To compare the effects of Dienogest (D) and Norethindrone acetate (N) in symptomatic women with ovarian endometriomas, analyzing the efficacy in reducing endometrioma size and symptom relief and drug tolerability. STUDY DESIGN: Retrospective study including 135 symptomatic women with ultrasonographic diagnosis of ovarian endometrioma. Women were divided into two groups: 1) women who received D 2 mg/day (group D); 2) women who received N 2.5 mg/day (group N). Women were evaluated at therapy prescription and after 6 and 12 months of treatment: transvaginal ultrasound was performed to assess the mean diameter of endometriomas, a Visual Analogue Scale was used to rank endometriosis related symptoms (dysmenorrhea, dyspareunia, chronic pelvic pain). The main outcome measure was the comparison between the 2 groups in terms of variations in endometrioma size and endometriosis related symptoms during the follow-up. Drug tolerability was also analyzed in terms of side effects. RESULTS: A reduction in ovarian endometrioma size was observed during treatment in both groups, with no significant differences between groups D and N. Endometriosis related symptoms decreased in both groups, but the decrease was significantly higher in group D than in group N for all symptoms, both at 6 and 12 months of treatment. Regarding drug tolerability, uterine bleeding/spotting and weight gain were reported more frequently by women in the group N than women in the group D, both at 6 and 12 months of treatment. CONCLUSION: Progestin therapy with D or N appears to be effective in reducing the size of endometriomas and related symptoms, with a greater effect on symptoms relief and higher tolerability in women treated with D.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Endometriose/tratamento farmacológico , Nandrolona/análogos & derivados , Noretindrona/uso terapêutico , Doenças Ovarianas/tratamento farmacológico , Adulto , Feminino , Humanos , Nandrolona/uso terapêutico , Estudos Retrospectivos
6.
Eur J Contracept Reprod Health Care ; 24(3): 175-181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31094588

RESUMO

Objective: In contrast with combined hormonal contraception, progestin-only contraception is not associated with an increase in venous thromboembolism or stroke. Women with migraine are at increased risk of ischaemic stroke. Several studies have reported a reduction in migraine frequency and intensity with desogestrel 75 µg, a progestin-only pill. At present the quality of data is limited by retrospective study designs, lack of control groups and small sample sizes. We present the first prospective nonrandomised controlled trial. Methods: A total of 150 women with migraine visiting our clinic for contraceptive counselling were screened. The intervention group comprised women who opted for contraception with desogestrel (n = 98); the control group comprised women who continued their usual contraceptive (n = 36). Participants completed daily diaries for 90 days before the intervention and 180 days after the intervention. Results: In the intervention group, we found improvements in migraine frequency (p < .001), migraine intensity (p < .001) and the number of triptans used (p < .001). These improvements were already significant after 90 days of desogestrel use (p < .001). Disability scores also decreased significantly. No improvement was seen in the nonintervention group. Conclusion: These data demonstrate for the first time in a prospective controlled setting that daily use of the progestin desogestrel is associated with a decrease in migraine frequency, migraine intensity and pain medication use in women with migraine, with and without aura, who had previously been experiencing at least three days of migraine per month. Trial registration: The study is registered in the University of Zürich database ( www.research-projects.uzh.ch/unizh.htm ).


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Desogestrel/uso terapêutico , Enxaqueca com Aura/prevenção & controle , Enxaqueca sem Aura/prevenção & controle , Adulto , Anticoncepcionais Orais Hormonais/administração & dosagem , Desogestrel/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Enxaqueca com Aura/tratamento farmacológico , Enxaqueca sem Aura/tratamento farmacológico , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Triptaminas/uso terapêutico
7.
Med Clin North Am ; 103(4): 613-628, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078196

RESUMO

Premenstrual dysphoric disorder (PMDD) comprises emotional and physical symptoms and functional impairment that lie on the severe end of the continuum of premenstrual symptoms. Women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions. Serotonin reuptake inhibitors are considered the first-line treatment. Second-line treatments include oral contraceptives containing drospirenone, other ovulation suppression methods, calcium, chasteberry, and cognitive-behavioral therapy.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Transtorno Disfórico Pré-Menstrual/diagnóstico , Transtorno Disfórico Pré-Menstrual/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Anticoncepcionais Orais/uso terapêutico , Feminino , Humanos , Síndrome Pré-Menstrual/diagnóstico , Síndrome Pré-Menstrual/tratamento farmacológico , Saúde da Mulher
8.
Ginekol Pol ; 90(2): 61-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860270

RESUMO

OBJECTIVES: The aim of the study was to evaluate hormonal contraception use in women with epilepsy and to assess the risk of potential interactions between contraceptives and antiepileptic drugs (AEDs). MATERIAL AND METHODS: Data on hormonal contraception were obtained prospectively in women of childbearing age treated in the university epilepsy clinic. RESULTS: We evaluated 334 women with epilepsy (mean age 30.2 years). The majority of patients took one AED (193, 58%); the most commonly prescribed AEDs were: valproate, levetiracetam or lamotrigine. Hormonal contraception was used by 19 (5.7%) of all women of childbearing age. Only 7 patients (37%) of all those using hormonal contraception used prepa- rations that did not interact with AEDs; what is more 145 (46%) patients who did not use hormonal contraception were prescribed AEDs with high teratogenic potential (valproate or/and topiramate). CONCLUSIONS: A very small percentage of women with epilepsy of childbearing potential used hormonal contraception. More than a half of that group simultaneously took AEDs that may interact with oral contraceptives. A large proportion of women taking AEDs with high teratogenic potential were not using hormonal contraception. As interaction between OC and AEDs are common, nonhormonal, highly effective methods, such as IUDs, may be ideal for women with epilepsy. The results of the study indicate the need for closer cooperation between neurologist and gynecologist caring for women with epilepsy.


Assuntos
Anticonvulsivantes/farmacocinética , Anticoncepcionais Orais Hormonais/farmacocinética , Interações Medicamentosas , Epilepsia/tratamento farmacológico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Anticoncepcionais Orais Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/uso terapêutico , Epilepsia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
9.
Dermatol Clin ; 37(2): 195-203, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850042

RESUMO

Therapeutic actives for acne have changed little in the last decade. Recognition that acne is an inflammatory condition, not an infectious one, has led to a call for reduction in antibiotic use, which has culminated in a re-evaluation of our nonantibiotic choices. Spironolactone and oral contraceptives have become more acceptable first-line choices, and earlier use of isotretinoin has been proposed.


Assuntos
Acne Vulgar/tratamento farmacológico , Anticoncepcionais Orais Hormonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Isotretinoína/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Espironolactona/uso terapêutico , Humanos
10.
Br J Cancer ; 120(7): 754-760, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30814688

RESUMO

BACKGROUND: Although the photosensitising effects of oestrogens may increase the impact of ultraviolet radiation (UVR) on melanoma risk, few prospective studies have comprehensively assessed the association between oestrogen-related factors and melanoma. METHODS: We examined the associations between reproductive factors, exogenous oestrogen use and first primary invasive melanoma among 167 503 non-Hispanic white, postmenopausal women in the NIH-AARP Diet and Health Study. Satellite-based ambient UVR estimates were linked to geocoded residential locations of participants at study baseline. RESULTS: Increased risk of melanoma was associated with early age at menarche (≤10 vs ≥15 years: HR = 1.25, 95% CI: 0.92, 1.71; P for trend = 0.04) and late age at menopause (≥50 vs <45 years: HR = 1.34, 95% CI: 1.13, 1.59; P for trend = 0.001). The relationship between ambient UVR and melanoma risk was highest among women with age at menarche ≤10 years (HR per UVR quartile increase = 1.29; 95% CI: 1.05, 1.58; P-interaction = 0.02). Melanoma risk was not associated with parity, age at first birth, use of oral contraceptives or use of menopausal hormone therapy. CONCLUSIONS: Our findings suggest that increased melanoma risk is associated with early age at menarche and late age at menopause. Effect modification findings support the hypothesis that endogenous oestrogen exposure in childhood increases photocarcinogenicity. Future studies should include information on personal UVR exposure and sun sensitivity.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Melanoma/epidemiologia , Menarca , Menopausa , Neoplasias Cutâneas/epidemiologia , Fatores Etários , Idoso , Estrogênios/uso terapêutico , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Raios Ultravioleta , Estados Unidos/epidemiologia
11.
Eur J Clin Pharmacol ; 75(6): 751-767, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30719565

RESUMO

PURPOSE: This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE). RESULTS: Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk. CONCLUSION: Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.


Assuntos
Assistência Perioperatória , Tromboembolia Venosa/induzido quimicamente , Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Diuréticos/uso terapêutico , Terapia de Reposição Hormonal , Humanos , Hipnóticos e Sedativos/uso terapêutico , Fatores de Risco
12.
Eur J Contracept Reprod Health Care ; 24(1): 61-70, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30664383

RESUMO

OBJECTIVE: A systematic review was carried out of studies of women with endometriosis, to examine the evidence for efficacy of the use of hormonal contraception to improve disease-related pain and decrease postoperative risk of disease recurrence. METHODS: A search of the Medline/PubMed and Embase databases was performed to identify all published English language studies on hormonal contraceptive therapies (combined hormonal contraceptives [CHCs], combined oral contraceptives [COCs], progestin-only pills [POPs] and progestin-only contraceptives [POCs]) in women with a validated endometriosis diagnosis, in comparison with placebo, comparator therapies or other hormonal therapies. Main outcome measures were endometriosis-related pain (dysmenorrhoea, pelvic pain and dyspareunia), quality of life (QoL) and postoperative rate of disease recurrence during treatment. RESULTS: CHC and POC treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in non-cyclical pelvic pain and dyspareunia and an improvement in QoL. Only two COC preparations (ethinylestradiol [EE]/norethisterone acetate [NETA] and a flexible EE/drospirenone regimen) demonstrated significantly increased efficacy compared with placebo. Only three studies found that the postoperative use of COCs (EE/NETA, EE/desogestrel and EE/gestodene) reduced the risk of disease recurrence. There was no evidence that POCs reduced the risk of disease recurrence. CONCLUSIONS: CHCs and POCs are effective for the relief of endometriosis-related dysmenorrhoea, pelvic pain and dyspareunia, and improve QoL. Some COCs decreased the risk of disease recurrence after conservative surgery, but POCs did not. There is insufficient evidence, however, to reach definitive conclusions about the overall superiority of any particular hormonal contraceptive.


Assuntos
Anticoncepção/métodos , Anticoncepcionais Orais Combinados/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Endometriose/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Adulto , Androstenos/uso terapêutico , Desogestrel/uso terapêutico , Combinação de Medicamentos , Endometriose/complicações , Etinilestradiol/uso terapêutico , Feminino , Humanos , Noretindrona/uso terapêutico , Dor Pélvica/etiologia , Progestinas/uso terapêutico , Resultado do Tratamento
13.
Int J Gynecol Cancer ; 29(1): 77-85, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640687

RESUMO

OBJECTIVE: Hormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer. METHODS: We retrospectively analyzed patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups. RESULTS: Seventy-one patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4-49) and 12.0 months (range 3-35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20-38) and 12 months (range 4-48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test). CONCLUSIONS: A lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Endometrioide/tratamento farmacológico , Anticoncepcionais Orais Hormonais/uso terapêutico , Neoplasias do Endométrio/tratamento farmacológico , Preservação da Fertilidade/estatística & dados numéricos , Medroxiprogesterona/uso terapêutico , Adulto , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
14.
Gynecol Endocrinol ; 35(2): 100-102, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30599791

RESUMO

As obesity is considered to be a pandemic of the twenty-first century, the bariatric surgery becomes more common through the global population. The adverse effects of obesity on fertility can be reversed through the bariatric surgery procedures. In this review, we presented the effects of bariatric surgery on hypothalamic-pituitary-ovarian axis and fertility, ovarian reserve, and contraception efficacy.


Assuntos
Cirurgia Bariátrica , Anticoncepcionais Orais Hormonais/uso terapêutico , Fertilidade , Obesidade/cirurgia , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Infertilidade Feminina , Obesidade/metabolismo , Reserva Ovariana , Ovário/metabolismo , Gravidez , Resultado do Tratamento
15.
J Pediatr Adolesc Gynecol ; 32(2): 186-188, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30513343

RESUMO

BACKGROUND: After several visits with unrelated complaints, a 16-year-old female patient disclosed symptoms of unwanted genital arousal and was diagnosed with persistent genital arousal disorder (PGAD). CASE: A 16-year-old female patient with history of depression, sexual abuse, and dysmenorrhea insistently requested etonogestrel rod removal. At 2 visits after implant removal, the patient disclosed the reason for her insistence: PGAD symptoms developed after implant insertion, although they worsened with removal. Chart review revealed selective serotonin reuptake inhibitor discontinuation before symptom onset. Normalization of sexual arousal occurred with counseling, selective serotonin reuptake inhibitor treatment, and hormonal contraception. SUMMARY AND CONCLUSION: This case highlights the importance of clinician recognition of PGAD symptoms, which adolescents might not openly disclose. Clinicians must nonjudgmentally collect medication history and sexual history, including sexual arousal and satisfaction, to make this diagnosis.


Assuntos
Depressão/tratamento farmacológico , Inibidores de Captação de Serotonina/administração & dosagem , Disfunções Sexuais Psicogênicas/diagnóstico , Adolescente , Anticoncepcionais Orais Hormonais/uso terapêutico , Diagnóstico Diferencial , Feminino , Genitália , Humanos , Inibidores de Captação de Serotonina/efeitos adversos , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia
16.
Acta Obstet Gynecol Scand ; 98(2): 232-239, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30252134

RESUMO

INTRODUCTION: Immigrants and their offspring constitute 16.3% of the population in Norway. Knowledge about their contraceptive use is important in order to inform adequate family planning services. Prior research has shown less use of contraception among first-generation immigrants than among non-immigrant women. Our aim is to compare the use of hormonal contraceptives between immigrants and their adult daughters. MATERIAL AND METHODS: Information from the Norwegian Prescription Database on all hormonal contraceptives dispensed at all pharmacies in Norway in 2008 was merged with demographic, socioeconomic and immigration data from the National Population Register and information from the Regular General Practitioner Database and the Medical Birth Registry Norway. A total of 10 451 women aged 16-30 from five countries with relatively large numbers of immigrants and adult daughters living in Norway in 2008 were included in the study. Descriptive statistics and logistic regression analyses were conducted. The main outcome measure was use of any hormonal contraceptive. RESULTS: More daughters of immigrants from Vietnam compared with immigrant women from these countries (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.8-2.8) and Poland (OR 2.3, 95% CI: 1.6-3.3) used hormonal contraceptives. However, no adjusted differences between generations were detected for immigrants from Pakistan (OR 1.2, 95% CI 1.0-1.4), Morocco (OR 1.0, 95% CI 0.7-1.4) or Chile (OR 1.3, 95% CI 0.8-1.9). CONCLUSIONS: Further research should explore the reasons for heterogeneity in use of contraception among daughters of immigrants from different origins and explore whether daughters of immigrant mothers from some areas have unmet needs of contraception.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Serviços de Planejamento Familiar , Saúde da Mulher , Adolescente , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo/estatística & dados numéricos , Bases de Dados Factuais , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Mães , Noruega/epidemiologia , Núcleo Familiar , Saúde da Mulher/etnologia , Saúde da Mulher/estatística & dados numéricos
17.
Gynecol Endocrinol ; 35(2): 103-108, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30324830

RESUMO

Enhanced health care for patients with Down syndrome (DS) results in improved overall quality of life and longer life expectancy. The main gynecologic complaints of patients with DS and their caregivers relate to menstrual cycles, hygiene and reproductive issues. Certain aspects, such as age of menarche, menstrual cycles, internal genitalia, and hormone profile are similar to those observed in the general population. However, individuals with DS may have a higher incidence of other disorders related to menstruation, such as hypothyroidism, epilepsy and use of anticonvulsants. Contraceptive measures for individuals with DS can be used for both contraception and control of menstrual symptoms. The physician must be to make an individualized recommendation aimed at offering the most efficient and least invasive method with the fewest side effects. Among medical options are oral contraceptives, quarterly injectable medroxyprogesterone acetate, oral progesterone, a levonorgestrel-releasing intrauterine system, transdermal patch and vaginal rings. Surgical methods, including hysterectomy, endometrial ablation, or tubal ligation, are rarely considered because they raise ethical and legal questions. This article reviews the literature and basic guidelines to assist physicians who attend adolescent girls and women with DS to provide guidance on the appropriate management of the main gynecologic complaints of this population.


Assuntos
Anticoncepção , Anticoncepcionais Femininos/uso terapêutico , Síndrome de Down , Distúrbios Menstruais/tratamento farmacológico , Dispositivos Anticoncepcionais Femininos , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Humanos , Dispositivos Intrauterinos Medicados , Levanogestrel/uso terapêutico , Acetato de Medroxiprogesterona/uso terapêutico , Progesterona/uso terapêutico , Adesivo Transdérmico
18.
Gynecol Endocrinol ; 35(2): 124-127, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30303700

RESUMO

This study aims to investigate whether oral contraceptive pills (OCP) pretreatment impairs pregnancy outcomes in polycystic ovary syndrome (PCOS) women undergoing GnRH agonist protocol. A total of 1025 couples underwent their first cycle of in vitro fertilization. Patients were divided into GnRH agonist protocol group (LP group) and OCP dual suppression GnRH agonist protocol group (OC-LP group). Logistic regressions were performed to estimate the risk factors affecting live birth following fresh embryo transfer between groups. Frozen-thawed embryos from the first oocyte retrieval cycle were replaced into uterus for women did not get live birth. Cumulative live birth rates between groups were compared by Kaplan-Meier survival analysis. Serum luteinizing hormone level, endometrial thickness, and live birth rate were significantly reduced in the OC-LP group in fresh cycle. Thinner endometrium, higher progesterone, and poorer embryo quality were independent risk factors for failure in getting live birth following fresh embryo transfer. However, cumulative live birth rate, medium embryo transfer attempts required to achieve live birth were comparable between groups. OCP pretreatment in GnRH agonist protocol does not seem to impair the pregnancy outcome when calculated by cumulative live birth rate in PCOS women.


Assuntos
Anticoncepcionais Orais Hormonais/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Infertilidade Feminina/terapia , Nascimento Vivo , Indução da Ovulação/métodos , Adulto , Estudos de Casos e Controles , Transferência Embrionária , Endométrio/diagnóstico por imagem , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/etiologia , Modelos Logísticos , Hormônio Luteinizante/sangue , Recuperação de Oócitos , Síndrome do Ovário Policístico/complicações , Gravidez , Progesterona/sangue , Estudos Retrospectivos
19.
Gynecol Obstet Invest ; 84(3): 305-312, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30423566

RESUMO

Ovarian endometriotic cysts have been identified as the possible origin of ovarian clear cell carcinoma (OCCC), so predicting or preventing future transformation is important. Early detection of clear cell carcinoma is important because it shows low sensitivity to chemotherapy and the prognosis is worse than for other histologic types. We recently treated 2 patients with OCCC. They were both young women with no family history of cancer who received long-term oral contraceptive therapy for endometriotic cysts, and the histologic diagnosis was typical clear cell carcinoma in both patients. However, in Case 1, the tumor was detected by periodic examination, tumor expression of WT1 was positive, and the stage was IA. On the other hand, Case 2 presented with fever of unknown origin, her tumor showed expression of p53, and the stage was IVB. Case 1 is alive with no evidence of disease at 38 months after surgery, while Case 2 died after 19 months despite intensive treatment. These contrasting cases suggest that we need to be aware of the risk of cancer in young women receiving long-term hormone therapy for endometriotic cysts and that OCCC may show greater heterogeneity than what has been reported previously.


Assuntos
Adenocarcinoma de Células Claras/patologia , Endometriose/patologia , Cistos Ovarianos/patologia , Neoplasias Ovarianas/patologia , Adulto , Anticoncepcionais Orais Hormonais/efeitos adversos , Anticoncepcionais Orais Hormonais/uso terapêutico , Endometriose/tratamento farmacológico , Feminino , Humanos , Estadiamento de Neoplasias , Cistos Ovarianos/tratamento farmacológico , Prognóstico , Proteína Supressora de Tumor p53/análise , Proteínas WT1/análise
20.
Am J Obstet Gynecol ; 220(4): 376.e1-376.e12, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30576664

RESUMO

BACKGROUND: Nearly half of women will switch or discontinue using their selected contraceptive method in the first year. Research on early switching or discontinuation provides important clinical and public health insights, although few studies have assessed associated factors, particularly among longitudinal cohorts. OBJECTIVE: The current study explores attributes associated with early contraceptive method switching or discontinuation (<6 months of initiation) among participants enrolled in the intervention cohorts of the Highly Effective Reversible Contraceptive Initiative Salt Lake Contraceptive Initiative (Utah, United States). MATERIALS AND METHODS: Highly Effective Reversible Contraceptive Initiative Salt Lake participants have access to no-cost contraception for 3 years. This includes both the initial selection and the ability to switch or to discontinue methods without cost. Methods available included the following: nonhormonal behavioral methods (male/female condoms, withdrawal, diaphragms, cervical caps, and fertility awareness); short-acting methods (pill, patch, ring, and injectable); and long-acting methods (intrauterine devices and contraceptive implants). Participants completed surveys at baseline and at 1, 3, and 6 months. We collected data on participant demographics, contraceptive continuation, switching, and discontinuation, as well as factors associated with these changes, including established measures of pregnancy intention and ambivalence and reasons for switching or discontinuing. We conducted descriptive statistics, univariable, and multivariable Poisson regression analyses to assess predictors of both discontinuation and switching. We also conducted χ2 analyses to compare reported reasons for stopping between switchers and discontinuers. RESULTS: At 6 months, 2,583 women (70.0%) reported continuation of their baseline method, 367 (10%) reported at least 1 period of discontinuation, 459 (12.4%) reported switching to a different method, and 279 (7.6%) did not provide 6-month follow-up. Factors associated with discontinuation included selection of a short-acting method (incidence rate ratio [IRR], 2.49; 95% confidence interval [CI], 1.97, 3.12), report of Hispanic ethnicity (IRR, 1.45; 95% CI, 1.12, 1.89) and nonwhite race (IRR, 1.48; 95% CI, 1.08, 2.02), and having any future pregnancy plans, even years out. Participants with some college education were less likely to report discontinuation (IRR, 0.73; 95% CI, 0.57, 0.94). Selecting a short-acting method at baseline was also associated with increased likelihood of method switching (IRR, 2.29, 95% CI, 1.87, 2.80), as was having 2 or more children (IRR, 1.37; 95% CI, 1.08, 1.74). Women were less likely to switch if they were on their parents' insurance (IRR, 0.74; 95% CI, 0.56, 0.99). Among participants who switched methods, 36.9% switched to a long-acting reversible method, 31.7% switched to a short-acting hormonal method, and 31.1% switched to a nonhormonal behavioral method, such as condom use. Of participants providing a reason for stopping, 454 women (73.2%) reported side effects as 1 reason for switching or discontinuing their initial method. CONCLUSION: Early contraceptive method switching and discontinuation are frequent outcomes of contraceptive use. These changes are common even with removal of contraceptive access barriers.


Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo , Anticoncepcionais Orais Hormonais/uso terapêutico , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos , Coito Interrompido , Anticoncepção/estatística & dados numéricos , Escolaridade , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Intenção , Motivação , Métodos Naturais de Planejamento Familiar , Utah , Adulto Jovem
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