Low-dose Hormonal Contraceptives Research Articles

Menstrual Dysfunction in PCOS.

Menstrual irregularities due to anovulation or severe oligoovulation are a key feature of polycystic ovary syndrome for many women. First-line intervention should entail dietary and lifestyle modifications for overweight or obese polycystic ovary syndrome women. For women not seeking fertility, combination low-dose hormonal contraception are the most effective and first-line choice for regulating menstrual cycles. This option, as well as progestin-only options, have the important added benefit of reducing risks of endometrial hyperplasia and cancer. Metformin is an appropriate medical option to improve ovulation rates for women who cannot take combined hormone contraception or whom are attempting conception.

Breast cancer risk of hormonal contraception: Counselling considering new evidence.

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

Elagolix for endometriosis: all that glitters is not gold.

Elagolix, an orally active non-peptidic GnRH antagonist, has been approved by the Food and Drug Administration for the management of moderate to severe pain associated with endometriosis. As the degree of ovarian suppression obtained with elagolix is dose-dependent, pain relief may be achieved by modulating the level of hypo-oestrogenism while limiting side effects. Elagolix may thus be considered a novelty in terms of its endocrine and pharmacological properties but not for its impact on the pathogenic mechanisms of endometriosis, as the target of this new drug is, yet again, alteration of the hormonal milieu. Given the oestrogen-dependent nature of endometriosis, a reduction of side effects may imply a proportionate decrease in pain relief. Furthermore, if low elagolix doses are used, ovulation is not consistently inhibited, and patients should use non-hormonal contraceptive systems and perform serial urine pregnancy tests to rule out unplanned conception during periods of treatment-induced amenorrhoea. If high elagolix doses are used to control severe pain for long periods of time, add-back therapies should be added, similar to that prescribed when using GnRH agonists. To date, the efficacy of elagolix has only been demonstrated in placebo-controlled explanatory trials. Pragmatic trials comparing elagolix with low-dose hormonal contraceptives and progestogens should be planned to verify the magnitude of the incremental benefit, if any, of this GnRH antagonist over currently used standard treatments. The price of elagolix may impact on patient adherence and, hence, on clinical effectiveness. In the USA, the manufacturer AbbVie Inc. priced elagolix (OrilissaTM) at around $10 000 a year, i.e. $845 per month. When faced with unaffordable treatments, some patients may choose to forego care. If national healthcare systems are funded by the tax payer, the approval and the use of a new costly drug to treat a chronic condition, such as endometriosis, means that some finite financial resources will be diverted from other areas, or that similar patients will not receive the same level of care. Thus, defining the overall 'value' of a new drug for endometriosis also has ethical implications, and trade-offs between health outcomes and costs should be carefully weighed up.

синдром поликистозных яичников – 80 лет исследований и новые направления в изучении данного вопроса (обзор литературы)

The article presents the current data of history of polycystic ovary syndrome (PCOS) study. It contains studies of genetic susceptibility of PCOS, PCOS symptoms and connection with development of anxiety and depressive disorders. The article covers ethnic differences in the phenotypic manifestations of PCOS. The papers describes the study of endocrine causes of infertility in Russian and Buryat women. Several theories of PCOS, including the theory of PCOS connection with intestinal bacterial flora disorders (“dysbiotic intestinal microbiota”) are being discussed. The article also provides an overview of various scientific research in this area and the data of the relationship of PCOS and the risk of cardiometa-bolic disorders, insulin resistance, metabolic syndrome, obesity and sleep apnea. It highlights modern aspects in the study of PCOS etiology – studies of adipose tissue as an endocrine organ. The article reflects study of PCOS relationship with the level of the gastrointestinal tract hormones: leptin, insulin, ghrelin, cholecystokinin, peptide YY. The effect of short-term low-dose hormonal contraceptives on appetite levels in PCOS is covered. The scientific articles on the severity of hypertension in menopausal women with PCOS history and the presence of overweight are reviewed. The scientific work determines molecular genetic markers of PCOS in the aspect of the influence of environmental factors on the expression of genes.

Hormonal Contraception and Migraine: Clinical Considerations

Migraine is highly prevalent in women, particularly in the reproductive years when contraception may be needed. Preventive strategies are known to be underutilized for migraine. Women of reproductive age may not only benefit from the use of hormonal contraceptives for contraception, but also for the purpose of reducing the burden of menstrual-related migraine. Although migraine is associated with an increased risk of stroke, the use of low-dose hormonal contraceptives in otherwise healthy women does not appear to confer additional risk.

Menstrual Bleeding Patterns Associated with Continuous Use of the Contraceptive Ring

The introduction of low-dose hormonal contraception has raised questions about the merit of monthly hormone-free intervals. In a study partially funded

Contraception for obese women: challenges, concerns and recommendations for the future

One consequence of the worldwide obesity epidemic is the rapidly increasing cohort of reproductive-age obese women who face special challenges to achieve a healthy reproductive career. Popular low-dose hormonal contraceptives may be less effective in obese than in nonobese women. Cardiovascular and metabolic side effects associated with higher dose hormonal contraceptives may be exacerbated in obese women. Since obese women face an elevated risk of pregnancy complications, reducing unintended pregnancy by maximizing contraceptive effectiveness is of the utmost importance. To counsel women effectively, healthcare providers must be fully informed about all contraceptive options, as well as ways in which lifestyles can be modified to achieve and maintain a healthy weight. In the future, more research will be needed into the health effects of modern contraception in obese women.

Hormonal Oral Contraceptives, Urinary Porphyrin Excretion and Porphyrias

The influence of hormonal oral contraceptives on the urinary porphyrin excretion of 40 healthy females has been studied. Two different hormonal oral contraceptives (combinations of gestoden or desogestrel, respectively, and ethinylestradiol) were applied for half a year. In each case twenty women received one of these two combinations. Porphyrin precursors delta-aminolevulinic acid and porphobilinogen were normal in all subjects as well as the mean of uroporphyrin and coproporphyrin. One healthy female developed a mild secondary coproporphyrinuria. In this case coproporphyrin isomer I was slightly enhanced and isomer III slightly lowered. Furthermore it could be shown that three females with repeated premenstrual clinical expression of an acute hepatic porphyria (acute intermittent porphyria and hereditary coproporphyria) could be treated successfully with a hormonal oral contraceptive or other exogenous hormones to stabilize the latent, subclinical phase of the disease.

Preconception Counseling and Contraception After Gestational Diabetes

Women with gestational diabetes mellitus (GDM) diagnosed in the period 1978-1984 were followed for on average 6 yr after the index pregnancy. Thirty percent had diabetes mellitus at the follow-up examination, and preliminary results indicate that at least another third will develop diabetes during a subsequent pregnancy. Therefore, family planning and contraceptive guidance should follow the lines for women with pregestational diabetes. When low-dose hormonal contraceptives containing ethinyl estradiol and levonorgestrel were given to women with previous GDM, glucose tolerance and lipoprotein levels remained unchanged during a 6-mo treatment. However, insulin response to oral glucose increased significantly after hormonal intake for 6 mo. A triphasic preparation resulted in a significantly lower insulin response than a low-dose monophasic preparation. However, the results indicate that low-dose oral-contraceptive compounds appear to be safe for women with previous GDM when administered for limited periods. At the follow-up examination, we found no increased risk of developing diabetes in women with previous GDM who used oral contraception. We consider the intrauterine contraceptives (IUD) a safe and effective alternative for women with previous GDM. Of 154 women with GDM, 33% chose IUD, 22% a combination-type oral contraceptive, and 16% barrier methods as their first choice of contraception 2 mo postpartum. We conclude that family planning and qualified contraceptive advice are important in women with previous GDM.

Langzeituntersuchungen mit einem Antiandrogen/Östrogen-Kombinationspräparat zur Wirksamkeit, Leberverträglichkeit und Fettstoffwechsel bei Frauen

The usefulness of antiandrogenic therapy with cyproterone acetate for androgenisation signs and symptoms in women, when tumours are definitely not the cause, has now been confirmed world-wide in about 100,000,000 therapy cycles using the hormonal contraceptive Diane and its follow-up preparation Diane-35, which contains a lower level of oestrogen. Nowadays, low-dose hormonal contraceptives are preferred in order to minimise the so-called "internal" risk by reducing the level of the oestrogen component and, by careful selection of the progestin, minimising the residual androgenic effect. In an open study on 150 women with moderately severe symptoms of androgenisation, we assessed, for treatment periods of up to 36 cycles, the effect of the only oestrogen-reduced hormonal contraceptive with anti-androgenic activity (Diane-35), and also monitored biochemical parameters, which are indicative of high risk metabolic activity and permit an accurate characterisation of the hormonal contraceptive, especially with long-term use. Although the parameters of liver and fat metabolism occasionally yielded values close to the limit of the normal range, it was particularly favourable to note, that the lipoprotein fraction HDL exhibited a slightly rising tendency, whereas, at the same time, the LDL fraction dropped. Special attention has been paid to ultrasonographic monitoring of the liver, since the influence on the function of this organ has been frequently discussed in conjunction with prolonged use of 17-alpha-alkylated steroidal compounds, and because a possible connection between sex steroids and the development of liver tumours has been a point of discussions.(ABSTRACT TRUNCATED AT 250 WORDS)