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1.
Sci Med Footb ; 6(2): 153-158, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35475746

RESUMO

PURPOSE: To audit hormonal contraceptive use and associated symptomology in elite women's soccer in England. METHODS: Seventy-five elite women's soccer players from the Women's Super League (WSL) completed a questionnaire to assess: hormonal contraceptive (HC) use or non-use, reasons for initiation and discontinuation and the symptoms experienced by HC and non-HC users. RESULTS: Twenty-eight per cent reported current HC use, with 43% having used HCs previously. Combined HCs accounted for 62% of total usage, with progestin-only HCs making up the remainder. Eighty-six per cent pre-empted negative symptoms before commencing HCs, with 38% experiencing adverse symptoms. Negative symptoms were most common in progestin-only HC users (63%). Eighty-six per cent reported benefits associated with HC usage include pain management and the ability to predict or control their cycles. Six non-HC users reported amenorrhea, with one medically diagnosed. Negative MC-related symptoms were reported by 74%, with 4% unable to train due to these symptoms. Unfavorable symptoms typically occurred during the first days of menstruation (59%). CONCLUSION: Most WSL players do not currently use HCs (72%). Most HC users reported benefits of HC usage, whilst most non-HC users reported negative symptoms especially around menstruation. Practitioners should track players' MCs to help minimise discomfort and maximise performance.


Assuntos
Futebol , Cognição , Anticoncepcionais , Feminino , Humanos , Menstruação , Progestinas/efeitos adversos
2.
BMJ ; 376: o485, 2022 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-35260385

RESUMO

The studyVinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ 2020;371:m3873. To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/.


Assuntos
Neoplasias da Mama/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/métodos , Estrogênios/efeitos adversos , Progestinas/efeitos adversos , Fatores Etários , Idoso , Estudos de Casos e Controles , Didrogesterona/administração & dosagem , Didrogesterona/efeitos adversos , Estrogênios/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Noretindrona/administração & dosagem , Noretindrona/efeitos adversos , Progestinas/administração & dosagem , Fatores de Risco , Fatores de Tempo
3.
Sci Rep ; 12(1): 1662, 2022 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-35102226

RESUMO

Women with chronic abnormal uterine bleeding-ovulatory dysfunction (AUB-O) are at increased risk of endometrial neoplasia. We conducted a non-inferiority randomized controlled trial to determine the effectiveness of two cyclic-progestin regimens orally administered 10 d/month for 6 months on endometrial protection and menstruation normalization in women with AUB-O. There were 104 premenopausal women with AUB-O randomized to desogestrel (DSG 150 µg/d, n = 50) or medroxyprogesterone acetate (MPA 10 mg/d, n = 54) group. Both groups were comparable in age (44.8 ± 5.7 vs. 42.5 ± 7.1 years), body mass index (24.8 ± 4.7 vs. 24.9 ± 4.7 kg/m2), and AUB characteristics (100% irregular periods). The primary outcome was endometrial response rate (the proportion of patients having complete pseudodecidualization in endometrial biopsies during treatment cycle-1). The secondary outcome was clinical response rate (the proportion of progestin withdrawal bleeding episodes with acceptable bleeding characteristics during treatment cycle-2 to cycle-6). DSG was not inferior to MPA regarding the endometrial protection (endometrial response rate of 78.0% vs. 70.4%, 95% CI of difference - 9.1-24.4%, non-inferiority limit of - 10%), but it was less effective regarding the menstruation normalization (acceptable bleeding rate of 90.0% vs 96.6%, P = 0.016).Clinical trial registration: ClinicalTrials.gov (NCT02103764, date of approval 18 Feb 2014).


Assuntos
Desogestrel/administração & dosagem , Endométrio/efeitos dos fármacos , Acetato de Medroxiprogesterona/administração & dosagem , Menstruação/efeitos dos fármacos , Ovário/efeitos dos fármacos , Ovulação/efeitos dos fármacos , Progestinas/administração & dosagem , Hemorragia Uterina/tratamento farmacológico , Adulto , Desogestrel/efeitos adversos , Método Duplo-Cego , Endométrio/fisiopatologia , Feminino , Humanos , Acetato de Medroxiprogesterona/efeitos adversos , Pessoa de Meia-Idade , Ovário/fisiopatologia , Progestinas/efeitos adversos , Estudos Prospectivos , Tailândia , Fatores de Tempo , Resultado do Tratamento , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/fisiopatologia
4.
JAMA ; 327(1): 59-66, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982120

RESUMO

Importance: The incidence of central nervous system (CNS) tumors in children appears to be increasing, yet few risk factors are established. There is limited information regarding whether maternal hormonal contraception use increases this risk. Objective: To examine the association between maternal hormonal contraception use and CNS tumors in children (<20 years). Design, Setting, and Participants: In this nationwide cohort study based on population-based registry data, 1 185 063 children born in Denmark between January 1, 1996, and December 31, 2014, were followed up for a diagnosis of a CNS tumor (final follow-up on December 31, 2018). Exposures: Maternal hormonal contraception use was analyzed according to any use, regimen (combined/progestin only), and route of administration (oral/nonoral), categorized as recent use (≤3 months before start and during pregnancy), previous use (>3 months before start of pregnancy), and no use. For injections, implants, and intrauterine devices that are used for a different time period, the categorization was appropriately altered. Main Outcomes and Measures: Hazard ratio (HR) and incidence rate difference (IRD) of CNS tumors diagnosed at younger than 20 years. Results: After 15 335 990 person-years of follow-up (mean follow-up, 12.9 years), 725 children were diagnosed with a CNS tumor. The mean age at diagnosis was 7 years, and 342 (47.2%) of the diagnosed children were female. The adjusted incidence rate of CNS tumors per 100 000 person-years was 5.0 for children born to mothers with recent hormonal contraception use (n = 136 022), 4.5 for children born to mothers with previous use (n = 778 843), and 5.3 for children born to mothers with no use (n = 270 198). The corresponding HRs were 0.95 ([95% CI, 0.74-1.23]; 84 children with CNS tumors; IRD, -0.3 [95% CI, -1.6 to 1.0]) for recent use and 0.86 ([95% CI, 0.72-1.02]; 421 children with CNS tumors; IRD, -0.8 [95% CI, -1.7 to 0.0]) for previous use, compared with no use. No statistically significant associations were found for recent or previous use of oral combined, nonoral combined, oral progestin only, or nonoral products compared with no use of hormonal contraception. Conclusions and Relevance: Among Danish children, there was no statistically significant association between any maternal hormonal contraception use and CNS tumor risk.


Assuntos
Neoplasias do Sistema Nervoso Central/induzido quimicamente , Contraceptivos Hormonais/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Progestinas/efeitos adversos , Sistema de Registros , Fatores de Risco
5.
Contraception ; 107: 1-9, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34752778

RESUMO

OBJECTIVE: Studies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. STUDY DESIGN: Systematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). RESULTS: Among nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5-2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. CONCLUSION: We found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. IMPLICATIONS: Use of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.


Assuntos
Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/complicações , Neoplasia Intraepitelial Cervical/epidemiologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Contracepção Hormonal , Humanos , Infecções por Papillomavirus/induzido quimicamente , Infecções por Papillomavirus/complicações , Progestinas/efeitos adversos , Estudos Prospectivos , Neoplasias do Colo do Útero/epidemiologia
6.
Basic Clin Pharmacol Toxicol ; 130(2): 268-276, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34806331

RESUMO

Progesterone is an important natural hormone regulating ovulation and menstruation. The present study aimed to investigate the pharmacokinetics and safety of two formulations of progesterone in Chinese postmenopausal females under fasting and fed conditions. The study adopted a single-dose, open-label, randomized, three-period bioequivalence design. A total of 96 subjects were enrolled and randomly assigned to the fasting cohort or fed cohort. A high-fat meal (890 kcal) was used in the fed study. The reference-scaled average bioequivalence method was used for bioequivalence evaluation. A high-fat meal led to a 22-fold higher peak concentration (Cmax ) and a 7-fold higher area under the curve (AUC) while time to reach Cmax and half-life was not significantly affected. The concentration-time curve displayed double peaks suggesting the existence of enterohepatic circulation. The test/reference geometric mean ratios for Cmax and AUC under fasting and fed conditions are all within the range of 80% to 125%. All adverse events (AEs) that occurred during the trial were mild and did not cause drop-out, though these AEs occurred more frequently under fed state. In conclusion, the two formulations of progesterone are bioequivalent in Chinese subjects under fasting and fed conditions. Drug label modification regarding food effects needs further discussion.


Assuntos
Interações Alimento-Droga , Pós-Menopausa , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Área Sob a Curva , Estudos de Coortes , Gorduras na Dieta , Jejum , Feminino , Meia-Vida , Humanos , Pessoa de Meia-Idade , Progesterona/efeitos adversos , Progesterona/farmacocinética , Progestinas/efeitos adversos , Progestinas/farmacocinética , Equivalência Terapêutica
7.
Int J Gynaecol Obstet ; 156(3): 383-393, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33864694

RESUMO

BACKGROUND: Progesterone is widely used to prevent threatened miscarriage. OBJECTIVE: To determine the efficacy and safety of progestogens in the treatment of threatened miscarriage. SEARCH STRATEGY: PubMed, Cochrane Library, EMBASE, CNKI, CBM, and WanFang databases were searched for randomized controlled trials (RCTs) published from the date of inception of the database to August 2020. The search terms included "abortion, threatened," "progesterone," and "progestogens." SELECTION CRITERIA: A network meta-analysis was conducted of all the RCTs on threatened abortion so far to compare the efficacy and safety of different progestogens in the treatment of threatened abortion. DATA COLLECTION AND ANALYSIS: Odds ratios for dichotomous data with 95% confidence intervals were calculated and the data were pooled using a random-effects model. The surface under the cumulative ranking area (SUCRA) was calculated for efficacy and safety with different interventions. MAIN RESULTS: A total of 59 RCTs with 10 424 participants were included. Oral dydrogesterone (DYD) had the lowest risk of miscarriage (SUCRA 100.0%), followed by vaginal progesterone (SUCRA 67.9%). Oral micronized progesterone had the highest risk of miscarriage (SUCRA 15.7%). CONCLUSION: Oral DYD is effective in the treatment of threatened miscarriage. The results of the present study can help patients make informed decisions about treatment options for threatened miscarriage.


Assuntos
Aborto Espontâneo , Ameaça de Aborto , Aborto Espontâneo/prevenção & controle , Ameaça de Aborto/tratamento farmacológico , Ameaça de Aborto/prevenção & controle , Feminino , Humanos , Metanálise em Rede , Gravidez , Progesterona , Progestinas/efeitos adversos
9.
Heart Rhythm ; 19(1): 41-48, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34339849

RESUMO

BACKGROUND: Use of oral contraceptives (OCs) may modulate the clinical course of women with congenital long QT syndrome (LQTS). The safety of OC use by sex hormone content has not been assessed in women with LQTS. OBJECTIVE: We aimed to evaluate the association of OCs with the risk of cardiac events (CEs) in women with LQTS. METHODS: Beginning in 2010, information on menarche onset, OC use, pregnancy, and menopause were obtained from women enrolled in the Rochester LQTS Registry. Type of OC was categorized as progestin-only, estrogen-only, or combined (estrogen/progestin). Andersen-Gill multivariate modeling was used to evaluate the association of time-dependent OC use with the burden of CE (total number of syncope, aborted cardiac arrest, and LQTS-related sudden cardiac death) from menarche onset through 40 years. Findings were adjusted for genotype, corrected QT duration, and time-dependent ß-blocker therapy. RESULTS: A total of 1659 women with LQTS followed through March 2021, of whom 370 (22%) were treated with an OC. During a cumulative follow-up of 35,797 years, there were a total of 2027 CE. Multivariate analysis showed that progestin-only OC was associated with a pronounced 2.8-fold (P = .01) increased risk of CEs in women who did not receive ß-blocker therapy, while ß-blockers were highly protective during progestin-only OC treatment (hazard ratio 0.22; P = .01; P = .006 for ß-blocker-by-OC interaction). The risk associated with OC use without concomitant ß-blocker treatment was pronounced in women with LQTS type 2. CONCLUSION: Our findings suggest that progestin-only OC should not be administered in women with LQTS without concomitant ß-blocker therapy. OCs should be used with caution in women with LQTS type 2.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anticoncepcionais Orais/efeitos adversos , Síndrome do QT Longo/tratamento farmacológico , Adolescente , Feminino , Genótipo , Humanos , Síndrome do QT Longo/genética , Progestinas/efeitos adversos , Sistema de Registros , Medição de Risco , Fatores de Risco , Adulto Jovem
10.
Minerva Obstet Gynecol ; 73(6): 678-696, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905875

RESUMO

INTRODUCTION: Short-term and long-term steroid contraceptive systems are widely employed in adolescents and premenopausal women; they could induce variation in bone metabolism, but whether these changes increase the overall fracture risk is not yet clear. EVIDENCE ACQUISITION: A systematic search of scientific publications about "hormonal contraceptives" and "bone metabolism" in reproductive age women was conducted. EVIDENCE SYNTHESIS: In adolescent girl, combined oral contraceptives could have a deleterious effect on bone health when their onset is within three years after menarche and when they contain ethinyl estradiol at the dose of 20 mcg. In perimenopausal women, steroid contraceptives seem not influence bone health nor increase osteoporotic fractures risk in menopause. The oral progestogens intake is not related to negative effects on skeletal health. Depot medroxyprogesterone acetate (DMPA) induce a prolonged hypoestrogenism with secondary detrimental effect on healthy bone; the higher bone loss was observed at the DMPA dose of 150 mg intramuscular such as after long-term DMPA-users. Progestin-based implants and intrauterine devices have not negative effect on bone health. CONCLUSIONS: Since sex-steroid drugs induce variations in hormonal circulating concentrations, they may negatively affect bone metabolism. Contraceptive choice should be tailored evaluating any possible effect on bone health. Clinicians should always perform a precontraceptive counselling to identify any coexisting condition that may affect bone health. Further randomized studies are needed to confirm these results.


Assuntos
Densidade Óssea , Acetato de Medroxiprogesterona , Adolescente , Osso e Ossos , Feminino , Contracepção Hormonal , Humanos , Acetato de Medroxiprogesterona/efeitos adversos , Progestinas/efeitos adversos
11.
BMJ ; 374: n2182, 2021 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588168

RESUMO

OBJECTIVE: To assess the risks of developing dementia associated with different types and durations of menopausal hormone therapy. DESIGN: Two nested case-control studies. SETTING: UK general practices contributing to QResearch or the Clinical Practice Research Datalink (CPRD), using all links to hospital, mortality, and social deprivation data. PARTICIPANTS: 118 501 women aged 55 and older with a primary diagnosis of dementia between 1998 and 2020, matched by age, general practice, and index date to 497 416 female controls. MAIN OUTCOME MEASURES: Dementia diagnoses from general practice, mortality, and hospital records; odds ratios for menopausal hormone treatments adjusted for demographics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs. RESULTS: Overall, 16 291 (14%) women with a diagnosis of dementia and 68 726 (14%) controls had used menopausal hormone therapy more than three years before the index date. Overall, no increased risks of developing dementia associated with menopausal hormone therapy were observed. A decreased global risk of dementia was found among cases and controls younger than 80 years who had been taking oestrogen-only therapy for 10 years or more (adjusted odds ratio 0.85, 95% confidence interval 0.76 to 0.94). Increased risks of developing specifically Alzheimer's disease were found among women who had used oestrogen-progestogen therapy for between five and nine years (1.11, 1.04 to 1.20) and for 10 years or more (1.19, 1.06 to 1.33). This was equivalent to, respectively, five and seven extra cases per 10 000 woman years. Detailed risk associations for the specific progestogens studied are also provided. CONCLUSION: This study gives estimates for risks of developing dementia and Alzheimer's disease in women exposed to different types of menopausal hormone therapy for different durations and has shown no increased risks of developing dementia overall. It has shown a slightly increased risk of developing Alzheimer's disease among long term users of oestrogen-progestogen therapies.


Assuntos
Doença de Alzheimer/induzido quimicamente , Demência/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Estudos de Casos e Controles , Bases de Dados Factuais , Demência/epidemiologia , Terapia de Reposição de Estrogênios/métodos , Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Progestinas/efeitos adversos , Fatores de Risco , Reino Unido/epidemiologia
12.
PLoS One ; 16(9): e0257778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34582488

RESUMO

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


Assuntos
Anticoncepcionais Orais Hormonais/administração & dosagem , Progestinas/efeitos adversos , Reabsorção da Raiz/epidemiologia , Mobilidade Dentária/epidemiologia , Adolescente , Adulto , Animais , Animais de Laboratório , Anticoncepcionais Orais Hormonais/efeitos adversos , Modelos Animais de Doenças , Feminino , Hormônios Esteroides Gonadais , Humanos , Pessoa de Meia-Idade , Reabsorção da Raiz/etiologia , Fatores de Tempo , Mobilidade Dentária/etiologia , Adulto Jovem
13.
Menopause ; 28(11): 1204-1208, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34581294

RESUMO

OBJECTIVES: Although menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms of menopause, its association with the development of arterial hypertension remains unclear. We sought to explore associations between different formulations of MHT and incident hypertension among menopausal women in a prospective cohort study. METHODS: We used the Etude Epidémiologique de femmes de la Mutuelle Générale de l'Education (E3N) cohort, a French prospective population-based study initiated in 1990 on 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included. RESULTS: The mean age of the population at baseline was 54.2 ±â€Š4.3 years, and 32,183 (64.5%) reported ever using MHT. Among these women, 10,173 cases of incident hypertension were identified over an average follow-up time of 10.6 years. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02-1.12) after adjustment for body mass index and other potential confounders. Oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04-1.14 and HR = 1.03; 95% CI: 0.99-1.07, respectively). However, the HRs associated with oral and transdermal estrogens did not differ significantly (P-homogeneity = 0.09). Regarding the role of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06-1.19 and HR = 1.06; 95% CI: 1.01-1.13, respectively). CONCLUSIONS: MHT was associated with a modest but significant increased risk of incident hypertension, especially when using oral estrogen in combination with a progestogen such as pregnane and norpregnane derivatives. Surveillance of blood pressure should be added to the medical surveillance of MHT users.


Video Summary:http://links.lww.com/MENO/A802.


Assuntos
Hipertensão , Progestinas , Estudos de Coortes , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Hipertensão/epidemiologia , Menopausa , Pessoa de Meia-Idade , Progestinas/efeitos adversos , Estudos Prospectivos , Fatores de Risco
14.
Ther Umsch ; 78(8): 447-455, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34555976

RESUMO

Clinical evaluation of progestogens used in Menopausal Hormone Therapy (MHT) Abstract. Primary indication for progestogens in MHT is to avoid estrogen-induced endometrial cancer. Progesteron has the least endometrial efficacy but is used increasingly (together with transdermal estradiol) because it is neutral in vascular and metabolic systems and possibly may have a lower risk of breast cancer. Comparable is dydrogesterone, the retro-isomer of progesterone, but with higher endometrial efficacy. However, also other progestogens (including tibolone) are used to take advantage of the androgenic, anti-androgenic and anti-mineralocorticoid "partial effects". Based on the results of the Women's Health Initiative Study the use of progestogens in MHT can cause an increased risk of breast cancer and coronary artery disease. Using different progestogens this is confirmed in various observational studies, which also suggest an increased progestogen-dependent risk of stroke. Since with every MHT early start can reduce cardiovascular risk or even act preventive, the decisive question remains, if there may be a screening regarding already known mechanisms for hormone-dependent development of breast cancer, at least for patients with increased risk of breast cancer. For this, new own research results are described.


Assuntos
Neoplasias da Mama , Progestinas , Neoplasias da Mama/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Menopausa , Progestinas/efeitos adversos
15.
Best Pract Res Clin Endocrinol Metab ; 35(6): 101578, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34583890

RESUMO

Hormone therapy is the most effective treatment for menopause-related symptoms. Current evidence supports its use in young healthy postmenopausal women under the age of 60 years, and within 10 years of menopause, with benefits typically outweighing risks. However, decision making is more complex in the more common clinical scenario of a symptomatic woman with one or more chronic medical conditions that potentially alter the risk-benefit balance of hormone therapy use. In this review, we present the evidence relating to the use of hormone therapy in women with chronic medical conditions such as obesity, hypertension, dyslipidemia, diabetes, venous thromboembolism, and autoimmune diseases. We discuss the differences between oral and transdermal routes of administration of estrogen and the situations when one route might be preferred over another. We also review evidence regarding the effect of different progestogens, when available.


Assuntos
Terapia de Reposição de Estrogênios , Menopausa , Estrogênios , Feminino , Terapia de Reposição Hormonal , Humanos , Pessoa de Meia-Idade , Progestinas/efeitos adversos
16.
Taiwan J Obstet Gynecol ; 60(5): 894-898, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507668

RESUMO

OBJECTIVE: Impact of environmental, maternal, paternal, and fetal factors on the development of hypospadias have been questioned in association with disrupted hormonal balance. We aimed to examine the association between maternal progesterone use and the associated risk factors and hypospadias. MATERIALS AND METHODS: There were 429 male children as the cases with hypospadias (n = 280, Group 1) and the controls without hypospadias (n = 149, Group 2). Those working in agriculture and industry, cleaners, and hairdressers were determined as risky occupational groups concerning the exposure of estrogenic endocrine disrupters. The association of progestin usage and the other risk factors with hypospadias were the study outcomes. RESULTS: The median gestational age was significantly lower in Group 2 (p = 0.019). Prematurity was more common in Group 1 (p = 0.043). Although the median birth weight in Group 1 was significantly lower (p < 0.001), there was no significant difference between the ratios of low birth weight babies in the groups. The risky occupations were more frequently detected in Group 2 (p = 0.001). The rate and duration of progestin usage in Group 1 were significantly higher than that in Group 2 (p < 0.001). CONCLUSION: Low birth weight and the use and duration of progestins during pregnancy were significantly associated with increased hypospadias risk.


Assuntos
Hipospadia/induzido quimicamente , Exposição Materna/efeitos adversos , Exposição Ocupacional/efeitos adversos , Progesterona/efeitos adversos , Progestinas/efeitos adversos , Adulto , Estudos de Casos e Controles , Criança , Feminino , Humanos , Hipospadia/epidemiologia , Recém-Nascido de Baixo Peso , Masculino , Idade Materna , Pais , Idade Paterna , Gravidez , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco
17.
Can J Physiol Pharmacol ; 99(12): 1316-1323, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34310895

RESUMO

Free fatty acid (FFA) deposition in non-adipose tissues such as the heart is a characteristic of insulin resistant states which feature hyperinsulinemia and dipeptidyl peptidase-4 (DPP-4) activation. Estrogen-progestin oral contraceptives (OC) treatment reportedly increased DPP-4 activity in rat tissue, and DPP-4 inhibitors have anti-diabetic and anti-inflammatory properties. This study aims to investigate the effects of DPP-4 inhibition on cardiac FFA deposition in estrogen-progestin-treated female rats. From our data, estrogen-progestin OC exposure in female rats led to elevated plasma insulin, cardiac DPP-4 activity, FFA and triglyceride (TG) accumulation, TG/high-density lipoprotein cholesterol (TG/HDL-C) ratio, adenosine deaminase/xanthine oxidase/uric acid pathway (ADA/XO/UA), lipid peroxidation, glycogen synthase activity, and alanine phosphatase; whereas cardiac glucose-6-phosphate dehydrogenase, Na+/K+-ATPase and nitric oxide (NO) were decreased. However, DPP-4 inhibition resulted in decreased plasma insulin, cardiac DPP-4 activity, FFA, TG, TG/HDL-C ratio, and alkaline phosphatase. These were accompanied by reduced ADA/XO/UA pathway, lipid peroxidation, and augmented NO and Na+/K+-ATPase in estrogen-progestin OC-treated rats. DPP-4 inhibition attenuated cardiac lipid deposition accompanied by reduced activity in the ADA/XO/UA pathway in estrogen-progestin OC-treated female rats. DPP-4 is therefore a plausible therapeutic target in cardiometabolic disorders.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Inibidores da Dipeptidil Peptidase IV/farmacologia , Estrogênios/efeitos adversos , Ácidos Graxos não Esterificados/metabolismo , Hiperinsulinismo/induzido quimicamente , Hiperinsulinismo/metabolismo , Miocárdio/metabolismo , Progestinas/efeitos adversos , Adenosina Desaminase/metabolismo , Animais , Dipeptidil Peptidase 4/metabolismo , Dipeptidil Peptidase 4/fisiologia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Feminino , Resistência à Insulina , Síndrome Metabólica/tratamento farmacológico , Síndrome Metabólica/metabolismo , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Ácido Úrico/metabolismo , Xantina Oxidase/metabolismo
18.
Gynecol Obstet Fertil Senol ; 49(5): 455-461, 2021 05.
Artigo em Francês | MEDLINE | ID: mdl-33757918

RESUMO

The incidence of venous thromboembolism (VTE) increases with age with an annual incidence of 1.25/1000 women in the 40-59 age group. Menopausal hormone therapy (MHT) may also increase the risk of VTE. This risk must be assessed during the first consultation before initiating MHT and assess each renewal of the MHT. MHT with oral estrogen combined (or not) with progestin increases the risk of VTE by about 70%. Using transdermal estrogen does not appear to increase the risk of VTE in women. VTE risk appears to be modulated by the type of progestin combined in MHT. The risk of VTE associated with MHT with transdermal estradiol appears to be safe in women using micronised progesterone and pregnane derivatives and higher in women using norpregnane derivatives . To limit the risk of VTE associated with MHT, transdermal estradiol use is recommended. In women at risk of VTE, MHT with oral estrogen is contraindicated. MHT with transdermal estradiol associated (or not) with micronised progesterone or dydrogesterone may be used in women with low or moderate risk of VTE.


Assuntos
Terapia de Reposição de Estrogênios , Pós-Menopausa , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Menopausa , Progestinas/efeitos adversos
20.
Climacteric ; 24(3): 236-245, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33733982

RESUMO

Hormone replacement therapy in menopause is used to improve climacteric syndrome in women whose quality of life is affected. However, given the wide variety of progestogens available, it is important to evaluate their differential benign changes (radiological, cellular, and clinical) on the breast. This review aimed to determine the different benign changes of progestogens used in postmenopausal combined hormone therapy on the breast (radiological, cellular, and clinical), in women without mammary pathology, in order to establish their safety profile. A systematic review of the literature was carried out with a balanced search strategy for the identification of relevant references in the MEDLINE, BVSalud, EMBASE, ProQuest, and Cochrane databases until November 2019. The search terms used were 'menopause' or 'hormonal replacement therapy' or 'progestins' or 'estrogen' or 'mastodynia' or 'benign breast disease' or 'mammography'. Data were collected from the 'eligible' articles by two researchers (ARF and SHA), and possible discrepancies in inclusion were resolved by consensus. A total of 1886 articles were identified; 60 full-text articles were reviewed, and 17 articles that met the inclusion criteria were included for the qualitative analysis. In conclusion, combined hormone replacement therapy is associated with benign effects on the breast, such as mastodynia and increased mammographic density.


Assuntos
Doenças Mamárias/induzido quimicamente , Mama/efeitos dos fármacos , Terapia de Reposição de Estrogênios/efeitos adversos , Pós-Menopausa/efeitos dos fármacos , Progestinas/efeitos adversos , Densidade da Mama/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade
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