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CONTRACEPTIVES HORMONAL [keywords]
- Passage of Decidual Cast Following Poor Compliance with Oral Contraceptive Pill. [JOURNAL ARTICLE]
- Fetal Pediatr Pathol 2014 Oct 29.
Background: Decidual cast describes the spontaneous sloughing of endometrium as an entire piece while retaining the shape of the endometrial cavity. It may be associated with increased serum progesterone levels and must be considered as a differential diagnosis in a patient who passes tissue per vagina while on progesterone containing hormonal contraception. Case: A 13-year-old adolescent with a history of menorrhagia since menarche, presented to the pediatric emergency room with worsening abdominal pain and heavy vaginal bleeding stopping her oral contraceptive pill 10 days prior to presentation. Her symptoms resolved spontaneously following passage of tissue per vagina which was later by histopathology to be a decidual cast. Conclusion: Decidual cast is a rare pathological entity that may be a side effect of progesterone-containing hormonal contraceptives, requiring patient education before use.
- Hormonal contraception and regulation of menstruation: a study of young women's attitudes towards 'having a period' [JOURNAL ARTICLE]
- J Fam Plann Reprod Health Care 2014 Oct 27.
Irregular bleeding is one of the most common side effects of hormonal contraception and a key reason for the discontinuation of hormonal methods.A qualitative study in which 12 young women volunteered to be interviewed in depth, along with six focus group discussions (23 participants). The study had two main research objectives: to document and investigate what young women think and feel about menstruation and contraception, and to explore young women's preferences regarding the intersection of contraceptives and bleeding patterns.Although participants held a broad view that menstruation can be an inconvenience, they did ascribe positive values to having a regular bleed. Bleeding was seen as a signifier of non-pregnancy and also an innate part of being a woman. A preference for a 'natural' menstruating body was a strong theme, and the idea of selecting a hormonal contraceptive that might stop the bleeding was not overly popular, unless the young woman suffered with painful natural menstruation. Contraceptives that mimicked the menstrual cycle were acceptable to most, suggesting that cyclic bleeding still holds a symbolic function for women.When counselling young women about the effect of different contraceptive modalities on their bleeding, practitioners should explore how the women feel about their bleeding, including how they might feel if their bleeding stopped or if they experienced erratic bleeding patterns. Practitioners also need to recognise the subjective understanding of the 'natural body' as held by some women, and in these cases to support them in their seeking out of non-hormonal methods of contraception.
- Clinical Characteristics and Survival of Patients With an Adult-Type Ovarian Granulosa Cell Tumor: A 56-Year Single-Center Experience. [JOURNAL ARTICLE]
- Int J Gynecol Cancer 2014 Oct 24.
The objective of this study was to evaluate clinical prognostic factors and survival of patients with ovarian granulosa cell tumors (GCTs) in a long-term follow-up study.A total of 240 adult-type GCTs diagnosed in Helsinki University Central Hospital from 1956 to 2012 were histologically reevaluated. Data were analyzed for several clinical factors in relation to major developments in imaging, surgery, and chemotherapy: the old era (1956-1983) and the new era (1984-2012). Prognostic factors for survival were evaluated in the univariate and multivariate analyses.The original diagnosis was confirmed in 187 (77.9%) patients. The International Federation of Gynecology and Obstetrics stage I disease was present in 89.2%; stage II, in 7.0%; stage III, in 3.8%; and stage IV, in 0% of cases. The mean age at diagnosis (52.9 years) and the mean tumor size (10.8 cm) did not change significantly over time. The most common presenting symptom was abnormal bleeding, but 14% were asymptomatic. The mean follow-up period was 15.7 years. Recurrence rate was similar in both eras. The GCT-specific 5-, 10-, and 20-year survival rates were 95.6%, 88.1%, and 79.8% in the old era as well as 97.2%, 94.8%, and 94.8% in the new era, respectively. In the univariate analyses, old era, patient age older than 60 years, tumor size greater than 10 cm, advanced stage, residual tumor, and use of hormonal adjuvant treatment were associated with GCT-related deaths. Prior use of oral contraceptives and history of infertility improved survival rates. In the multivariate analysis, stage was the only independent prognostic factor for GCT-specific survival.An accurate histological diagnosis of GCT is essential. Stage IV disease is an extreme rarity. However, tumor stage overcomes other possible clinical prognostic factors for GCT-specific survival. Fertility-sparing surgery, the use of oral contraceptives, or hormonal replacement therapy seems not to be risk factors for survival.
- Pharmacokinetic and Pharmacodynamic Drug Interactions Between Antiretrovirals and Oral Contraceptives. [JOURNAL ARTICLE]
- Clin Pharmacokinet 2014 Oct 21.
More than 50 % of women living with HIV in low- and middle-income countries are of reproductive age, but there are limitations to the administration of oral contraception for HIV-infected women receiving antiretroviral therapy due to drug-drug interactions caused by metabolism via the cytochrome P450 isoenzymes and glucuronidation. However, with the development of newer antiretrovirals that use alternative metabolic pathways, options for contraception in HIV-positive women are increasing. This paper aims to review the literature on the pharmacokinetics and pharmacodynamics of oral hormonal contraceptives when given with antiretroviral agents, including those currently used in developed countries, older ones that might still be used in salvage regimens, or those used in resource-limited settings, as well as newer drugs. Nucleos(t)ide reverse transcriptase inhibitors (NRTIs), the usual backbone to most combined antiretroviral treatments (cARTs) are characterised by a low potential for drug-drug interactions with oral contraceptives. On the other hand non-NRTIs (NNRTIs) and protease inhibitors (PIs) may interact with oral contraceptives. Of the NNRTIs, efavirenz and nevirapine have been demonstrated to cause drug-drug interactions; however, etravirine and rilpivirine appear safe to use without dose adjustment. PIs boosted with ritonavir are not recommended to be used with oral contraceptives, with the exception of boosted atazanavir which should be used with doses of at least 35 µg of estrogen. Maraviroc, an entry inhibitor, is safe for co-administration with oral contraceptives, as are the integrase inhibitors (INIs) raltegravir and dolutegravir. However, the INI elvitegravir, which is given in combination with cobicistat, requires a dose of estrogen of at least 30 µg. Despite the growing evidence in this field, data are still lacking in terms of large cohort studies, randomised trials and correlations to real clinical outcomes, such as pregnancy rates, in women on antiretrovirals and hormonal contraception.
- High prevalence of insulin resistance assessed by the glucose clamp technique in hormonal and non-hormonal contraceptive users. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2014 Oct 20.:1-9.
Objective To assess the prevalence of insulin resistance (IR) and associated factors in contraceptive users. Methods A total of 47 women 18 to 40 years of age with a body mass index (kg/m(2)) < 30, fasting glucose levels < 100 mg/dl and 2-hour glucose level < 140 mg/dl after a 75-g oral glucose load were submitted to a hyperinsulinemic-euglycemic clamp. The women were distributed in tertiles regarding M-values. The analysed variables were use of combined hormonal/non-hormonal contraception, duration of use, body composition, lipid profile, glucose levels and blood pressure. Results IR was detected in 19% of the participants. The women with low M-values presented significantly higher body fat mass, waist-to-hip ratio, fasting insulin, HOMA-IR and were nulligravida, showed > 1 year of contraceptive use and higher triglyceride levels. IR was more frequent among combined oral contraceptive users, however no association was observed after regression analysis. Conclusions The prevalence of IR was high among healthy women attending a family planning clinic independent of the contraceptive method used with possible long-term negative consequences regarding their metabolic and cardiovascular health. Although an association between hormonal contraception and IR could not be found this needs further research. Family planning professionals should be proactive counselling healthy women about the importance of healthy habits.
- Complementary and alternative treatments for primary dysmenorrhea in adolescents. [Journal Article]
- Nurse Pract 2014 Nov 16; 39(11):1-12.
: Primary dysmenorrhea is the most common gynecologic complaint among adolescents. Conventional treatments include nonsteroidal anti-inflammatory drugs and hormonal contraceptives, but complementary and alternative medicine is a growing area of interest. As patients seek such treatments, pediatric nurse practitioners should be aware of these options to offer the best advice to patients.
- Hormonal contraceptive use before and after conception in relation to preterm birth and small for gestational age: an observational cohort study. [JOURNAL ARTICLE]
- BJOG 2014 Oct 16.
To evaluate whether hormonal contraceptives, used before or in early pregnancy, confer increased risk of preterm birth or reduced fetal growth.Population-based cohort study conducted by the Norwegian Institute of Public Health (Mother and Child Cohort Study, 1998-2008) with linkage to the Norwegian Prescription Registry and to the Medical Birth Registry of Norway.Norway.Of the 48 615 pregnancies meeting study inclusion criteria, 44 734 pregnancies were included in the complete case analysis.We characterised hormonal contraception by type (combination oral, progestin-only oral, vaginal ring, transdermal, and injectable) and specific progestin component. We used generalised estimating equations to estimate the odds of adverse outcome according to formulation used. Several sensitivity analyses were conducted.Preterm birth, small for gestational age.We observed a positive association between use of a combination oral contraceptive and preterm birth for all exposure periods (e.g. adjusted odds ratio 1.21, 95% confidence interval 1.04-1.41 for last use 12 to >4 months before conception); combination contraceptives containing the progestin norethisterone were consistently related to risk. Other types of hormonal contraception were generally not associated with preterm birth; none were related to small for gestational age. Observed associations were robust to sensitivity analyses.Hormonally active agents may exert dose-, agent-, and timing-specific effects on growth and development. We found that the particular progestin component is important when assessing the potential for adverse effects among former users of hormonal contraceptives.
- Effects of combined hormonal contraception on health and wellbeing: Women's knowledge in northern Italy. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2014 Oct 15.:1-11.
Objectives We investigated levels of knowledge of the effects of combined hormonal contraceptives (CHCs) on general/reproductive health and physical/psychosexual wellbeing. Methods A cross-sectional study was conducted in two university hospitals in northern Italy. Healthy current-, past- and never CHC users (n = 545; age 18-44 years) completed a self-administered questionnaire. Results Ninety-three percent of current-, 74% of past-, and 56% of never users believed they were sufficiently informed (χ(2): 67.1; p = 0.001) about the benefits and risks of CHCs. Respondents mentioned: (i) a reduced risk of ovarian (67%) and endometrial (53%) cancer; (ii) an increased risk of thrombosis (82%); (iii) an increased risk of breast cancer (45%); (iv) a decreased fertility (19%) and no influence on risk of sexually transmitted infections (48%); (v) a reduced risk of menstrual abnormalities (77%) and acne (79%); (vi) less dysmenorrhoea (83%) and more headache (56%), weight gain (74%), increased appetite (51%), leg cramps (77%), mood swings (45%), vaginal dryness (47%), and low sex drive (48%). Beliefs about diseases/conditions and symptoms were influenced by CHC use. Conclusions CHC use is linked to good knowledge of risks and benefits. Our data suggest HCPs must be proactive in providing relevant information so that women can choose their contraception with a balanced insight of side effects.
- Intrauterine contraception. [Journal Article]
- Nurs Stand 2014 Oct 15; 29(7):19.
Essential facts Intrauterine contraception (IUC) methods are long-acting reversible contraceptives with licensed durations of use lasting between three and ten years. They include copper intrauterine devices (Cu-IUD), which are non-hormonal, and levonorgestrel intrauterine systems (LNG-IUS), which release levonorgestrel. They are suitable for most women, including those who have not been pregnant.
- Hormonal Contraception as Treatment for Heavy Menstrual Bleeding: A Systematic Review. [JOURNAL ARTICLE]
- Clin Obstet Gynecol 2014 Oct 14.
A systematic review to compare the effectiveness of contraceptives to treat heavy menstrual bleeding (HMB). PubMed was searched for studies using hormonal contraceptive methods to treat HMB. Two reviewers screened 734 citations and extracted eligible trials based on rigid inclusion and exclusion criteria. Fourteen articles met inclusion criteria. The evidence was good to poor quality and suggested that all contraceptives tested were effective in the treatment of HMB, but the levonorgestrel intrauterine system was the most effective method. Hormonal contraceptives effectively treat HMB. The levonorgestel intrauterine system is the superior method.