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CONTRACEPTIVES HORMONAL [keywords]
- Contraception in patients with systemic lupus erythematosus and antiphospholipid syndrome. [Journal Article]
- Lupus 2014 Oct; 23(12):1242-5.
Contraceptive choice in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) is challenging but important. Long-acting forms of contraception such as the progesterone intrauterine device (IUD) or subdermal implant are preferable for most patients. Estrogen-containing hormonal contraceptives may be used in stable, inactive SLE patients but are contraindicated in patients with positive antiphospholipid antibodies (aPL). The levonorgestrel IUD is a good alternative for many APS patients and often decreases menstrual blood loss. It is prudent to avoid depot medroxyprogesterone acetate (DMPA) in corticosteroid-treated or other patients at risk for osteoporosis because of the inhibition of ovulation. Effective and safe contraception in patients with SLE and APS permits planning for pregnancy during inactive disease and while on pregnancy-compatible medications, preventing a poorly timed pregnancy that may jeopardize maternal and/or fetal health.
- Hormonal contraception, thrombosis and age. [Journal Article]
- Expert Opin Drug Saf 2014 Oct; 13(10):1353-60.
This paper reviews the risk of thrombosis with use of different types of hormonal contraception in women of different ages.Combined hormonal contraceptives with desogestrel, gestodene, drospirenone or cyproterone acetate (high-risk products) confer a sixfold increased risk of venous thromboembolism as compared with nonusers, and about twice the risk as compared with users of products with norethisterone, levonorgestrel or norgestimate (low-risk products). Transdermal patches and vaginal ring belong to high-risk products. The risk of thrombotic stroke and myocardial infarction is increased 50 - 100% with use of combined products, with little difference in risk between different progestins. Progestin-only products do not confer any increased risk of venous or arterial thrombosis, except for progestin depot, which may double the risk of venous thrombosis.First choice in women below 35 years should be a combined low-risk pill, that is, with a second-generation progestin, with the lowest compliable dose of estrogen. Young women with risk factors of thrombosis such as age above 35 years, genetic predispositions, adiposity, polycystic ovary syndrome, diabetes, smoking, hypertension or migraine with aura should not use high-risk products, but should primarily consider progestin-only products, and be careful to use low-risk combined products.
- Emotional and cognitive functional imaging of estrogen and progesterone effects in the female human brain: A systematic review. [REVIEW]
- Psychoneuroendocrinology 2014 Aug 13.:28-52.
Ovarian hormones are pivotal for the physiological maintenance of the brain function as well as its response to environmental stimuli. There is mounting evidence attesting the relevance of endogenous ovarian hormones as well as exogenous estradiol and progesterone for emotional and cognitive processing. The present review systematically summarized current knowledge on sex steroid hormonal modulation of neural substrates of emotion and cognition revealed by functional magnetic resonance imaging (fMRI). Twenty-four studies of healthy naturally cycling and combined oral contraceptives (COC) user women, or women undergoing experimental manipulations, during their reproductive age, were included. Furthermore, six studies of premenstrual dysphoric disorder (PMDD), a hormonally based mood disorder, and three of gender dysphoria (GD), which provides an intriguing opportunity to examine the effect of high-dose cross-sex hormone therapy (CSHT) on brain functioning, were included. Globally, low (early follicular and the entire follicular phase for estrogen and progesterone, respectively) and high (COC, CSHT, late follicular and luteal phase for estrogen; COC, mid- and late-luteal phase for progesterone) hormonal milieu diversely affected the response of several brain regions including the amygdala, anterior cingulate cortex, and inferior frontal gyrus, but their functional recruitment across groups and domains was scattered. The constellation of findings provides initial evidence of the influence of sex steroid hormones on cortical and subcortical regions implicated in emotional and cognitive processing. Further well-powered and multimodal neuroimaging studies will be needed to identify the neural mechanism of functional brain alterations induced by sex steroid hormones.
- Managing menopause. [Journal Article]
- J Obstet Gynaecol Can 2014 Sep; 36(9):830-3.
To provide updated guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease, breast cancer, urogynaecology, and sexuality.Lifestyle interventions, prescription medications, and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms. Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are reviewed. Approaches to the identification and evaluation of women at high risk of osteoporosis, along with options for prevention and treatment, are presented in the companion osteoporosis guideline.Published literature was retrieved through searches of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary (e.g., hormone therapy, menopause, cardiovascular diseases, and sexual function) and key words (e.g., hormone therapy, perimenopause, heart disease, and sexuality). Results were restricted to clinical practice guidelines, systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to publication dates of 2009 onwards and to material in English or French. Searches were updated on a regular basis and incorporated in the guideline until January 5, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, national and international medical specialty societies, and clinical practice guideline collections.The quality of the evidence in this document was rated using the criteria described by the Report of the Canadian Task Force on Preventive Health Care (Table). Summary Statements and Recommendations Chapter 1: Assessment and Risk Management of Menopausal Women Recommendations for Patients 1. Women aged 51 to 70 should consume 7 servings of vegetables and fruits, 6 of grain products, 3 of milk and alternatives, and 2 of meat and alterna-tives daily. (III-A) 2. A diet low in sodium and simple sugars, with substitution of unsaturated fats for saturated and trans fats, as well as increased consumption of fruits, vegetables, and fibre, is recommended. (I-A) 3. Routine vitamin D supplementation and calcium intake for all Canadian adults year round is recommended. (I-A) 4. Achieving and maintaining a healthy weight throughout life is recommended. (I-A) 5. Women aged 18 to 64 should accumulate at least 150 minutes of moderate to vigorous aerobic physical activity per week in bouts of 10 minutes or more. (I-A) Recommendations for Health Care Providers 1. A waist circumference ≥ 88 cm (35 in) for women is associated with an increased risk of health problems such as diabetes, heart disease, and hypertension and should be part of the initial assessment to identify risk. (II-2A) 2. Tobacco-use status should be updated for all patients on a regular basis, (I-A) health care providers should clearly advise patients to quit, (I-C) the willingness of patients to begin treatment to achieve abstinence (quitting) should be assessed, (I-C) and every tobacco user who expresses the willingness to begin treatment to quit should be offered assistance. (I-A) 3. Blood pressure should be assessed and controlled as women go through menopause. (II-2B) If the systolic blood pressure is ≥ 140 mmHg and/or the diastolic blood pressure is ≥ 90 mmHg, a specific visit should be scheduled for the assessment of hypertension. (III-A) 4. Women ≥ 50 years of age or postmenopausal and those with additional risk factors, such as current cigarette smoking, diabetes, and arterial hypertension, should have lipid-profile screening done. (II-2A) 5. A cardiovascular risk assessment using the Framingham Risk Score should be completed every 3 to 5 years for women aged 50 to 75. (II-2A) 6. A history of past pregnancy complications (preeclampsia, gestational hypertension, gestational diabetes, placental abruption, idiopathic preterm delivery, and/or fetal growth restriction) should be elicited since it can often predict an increased risk for premature cardiovascular disease and cardiovascular death and may inform decisions about the need for screening. (II-2B) Chapter 2: Cardiovascular Disease Recommendations 1. Health care providers should not initiate hormone therapy for the sole purpose of preventing cardiovascular disease (coronary artery disease and stroke) in older postmenopausal women since there are no data to support this indication for hormone therapy. (I-A) 2. The risk of venous thromboembolism increases with age and obesity, in carriers of a factor V Leiden mutation, and in women with a history of deep vein thrombosis. Transdermal therapy is associated with a lower risk of deep vein thrombosis than oral therapy and should be considered only if the benefits outweigh the risks. (III-C) Health care providers should abstain from prescribing oral hormone therapy for women at high risk of venous thromboembolism. (I-A) 3. Health care providers should initiate other evidence-based therapies and interventions to effectively reduce the risk of cardiovascular disease events in women with or without vascular disease. (I-A) 4. Risk factors for stroke (obesity, hypertension, elevated cholesterol levels, diabetes, and cigarette smoking) should be addressed in all postmenopausal women. (I-A) 5. If prescribing hormone therapy to older postmenopausal women, health care providers should address cardiovascular risk factors; low- or ultralow-dose estrogen therapy is preferred. (I-B) 6. Health care providers may prescribe hormone therapy to diabetic women for the relief of menopausal symptoms. (I-A) Chapter 3: Menopausal Hormone Therapy and Breast Cancer Recommendations 1. Health care providers should periodically review the risks and benefits of prescribing hormone therapy to a menopausal woman in light of the association between duration of use and breast cancer risk. (I-A) 2. Health care providers may prescribe hormone therapy for menopausal symptoms in women at increased risk of breast cancer with appropriate counselling and surveillance. (I-A) 3. Health care providers should clearly discuss the uncer-tainty of risks associated with systemic hormone therapy after a diagnosis of breast cancer in women seeking treatment for distressing symptoms (vasomotor symptoms or vulvovaginal atrophy). (I-B) Chapter 4: Vasomotor Symptoms Recommendations 1. Lifestyle modifications, including reducing core body temperature, regular exercise, weight management, smoking cessation, and avoidance of known triggers such as hot drinks and alcohol, may be recommended to reduce mild vasomotor symptoms. (I-C) 2. Health care providers should offer hormone therapy, estrogen alone or combined with a progestin, as the most effective therapy for the medical management of menopausal symptoms. (I-A) 3. Progestins alone or low-dose oral contraceptives can be offered as alternatives for the relief of menopausal symptoms during the menopausal transition. (I-A) 4. Non-hormonal prescription therapies, including certain antidepressant agents, gabapentin, and clonidine, may afford some relief from hot flashes but have their own side effects. These alternatives can be considered when hormone therapy is contraindicated or not desired. (I-B) 5. There is limited evidence of benefit for most complementary and alternative approaches to the management of hot flashes. Without good evidence for effectiveness, and in the face of minimal data on safety, these approaches should not be recommended. Women should be advised that, until January 2004, most natural health products were introduced into Canada as "food products" and did not fall under the regulatory requirements for pharmaceutical products. As such, most have not been rigorously tested for the treatment of moderate to severe hot flashes, and many lack evidence of efficacy and safety. (I-B) 6. Estrogen therapy can be offered to women who have undergone surgical menopause for the treatment of endometriosis. (I-A) Chapter 5: Urogenital Health Recommendations 1. Conjugated estrogen cream, an intravaginal sustained-release estradiol ring, and low-dose estradiol vaginal tablets are recommended as effective treatment for vaginal atrophy. (I-A) 2. Routine progestin co-therapy is not required for endometrial protection in women receiving vaginal estrogen therapy in an appropriate dose. (III-C) 3. Vaginal lubricants may be recommended for subjective symptom improvement of dyspareunia. (II-2B) 4. Because systemic absorption of vaginal estrogen is minimal, its use is not contraindicated in women with contraindications to systemic estrogen therapy, including recent stroke and thromboembolic disease. (III-C) However, there are currently insufficient data to recommend its use in women with breast cancer who are receiving aromatase inhibitors (where the goal of adjuvant therapy is a complete absence of estrogen at the tissue level). Its use in this circumstance needs to be dictated by quality-of-life concerns after discussion of possible risks. (III-C) 5. Systemic estrogen therapy should not be recommended for the treatment of postmenopausal urge or stress urinary incontinence given the lack of evidence of therapeutic benefit. (I-A) Vaginal estrogen may, however, be recommended, particularly for the management of urinary urge incontinence. (II-1A) 6. As part of the management of stress incontinence, women should be encouraged to try non-surgical options, including weight loss (in obese women). (I-A) Pelvic floor physiotherapy, with or without biofeedback, (II-1B) weighted vaginal cones, (II-2B) functional electrical stimulation, (I-B) and/or intravaginal pessaries (II-2B) can also be recommended. 7. (ABSTRACT TRUNCATED)
- Sleep regulation and sex hormones exposure in men and women across adulthood. [REVIEW]
- Pathol Biol (Paris) 2014 Sep 10.
This review aims to discuss how endogenous and exogenous testosterone exposures in men and estrogens/progesterone exposures in women interact with sleep regulation. In young men, testosterone secretion peaks during sleep and is linked to sleep architecture. Animal and human studies support the notion that sleep loss suppresses testosterone secretion. Testosterone levels decline slowly throughout the aging process, but relatively few studies investigate its impact on age-related sleep modifications. Results suggest that poorer sleep quality is associated with lower testosterone concentrations and that sleep loss may have a more prominent effect on testosterone levels in older individuals. In women, sex steroid levels are characterized by a marked monthly cycle and reproductive milestones such as pregnancy and menopause. Animal models indicate that estrogens and progesterone influence sleep. Most studies do not show any clear effects of the menstrual cycle on sleep, but sample sizes are too low, and research designs often inhibit definitive conclusions. The effects of hormonal contraceptives on sleep are currently unknown. Pregnancy and the postpartum period are associated with increased sleep disturbances, but their relation to the hormonal milieu still needs to be determined. Finally, studies suggest that menopausal transition and the hormonal changes associated with it are linked to lower subjective sleep quality, but results concerning objective sleep measures are less conclusive. More research is necessary to unravel the effects of vasomotor symptoms on sleep. Hormone therapy seems to induce positive effects on sleep, but key concerns are still unresolved, including the long-term effects and efficacy of different hormonal regimens.
- Implications of prenatal steroid perturbations for neurodevelopment, behavior, and autism. [JOURNAL ARTICLE]
- Endocr Rev 2014 Sep 11.:er20131122.
The prenatal brain develops under the influence of an ever-changing hormonal milieu that includes endogenous fetal gonadal and adrenal hormones; placental and maternal hormones; and exogenous substances with hormonal activity that can cross the placental barrier. This review discusses the influences of endogenous fetal and maternal hormones on normal brain development, and potential consequences of pathophysiological hormonal perturbations to the developing brain, with particular reference to autism. We also consider the effects of hormonal pharmaceuticals used for assisted reproduction, the maintenance of pregnancy, the prevention of congenital adrenal hypertrophy, and hormonal contraceptives continued into an unanticipated pregnancy, among others. These treatments, while in some instances life-saving, may have unintended consequences on the developing fetuses. Additional concern is raised by fetal exposures to endocrine-disrupting chemicals (EDCs) encountered universally by pregnant women from food/water containers, contaminated food, household chemicals, and other sources. What are the potential outcomes of prenatal steroid perturbations on neurodevelopmental and behavioral disorders, including autism spectrum disorders? Our purposes here are: (i.) to summarize some consequences of steroid exposures during pregnancy for the development of brain and behavior in the offspring; (ii.) to summarize what is known about the relationships between exposures and behavior, including autism spectrum disorders; (iii.) to discuss the molecular underpinnings of such effects, especially molecular epigenetic mechanisms of prenatal steroid manipulations, a field that may explain effects of direct exposures, and even transgenerational effects; and (iv.) for all of these, to add cautionary notes about their interpretation in the name of scientific rigor.
- Should Home-Based Contraceptive Dispensing become a Routine part of Public Health Nurse Practice? Review of Nurse Perceptions. [JOURNAL ARTICLE]
- Public Health Nurs 2014 Sep 7.
We examined public health nurses' beliefs about the safety of dispensing hormonal contraceptives in the home, the extent to which they considered contraceptive dispensing within their scope of practice, and the types of support needed to effectively dispense contraceptives in the home.We conducted focus groups in Washington State with 24 home visiting nurses participating in a Nurse Family Partnership (NFP) randomized clinical trial in which nurses dispensed hormonal contraceptives during home visits.We assessed the feasibility of the intervention and barriers and facilitators to home dispensing of hormonal contraceptives.Nurses were, on average 52 years old and had been working in nursing approximately 25 years, with between 5 and 18 years of experience working in a family planning setting. Overall, nurses believed that, with the right training and support, dispensing of hormonal contraceptives in the home was safe and fit within their scope of practice. Those nurses who reported resistance to the intervention cited inadequate training, lack of clear protocols, and sufficient support as important deterrents.Home-based contraceptive dispensing by nurses is a feasible enhancement of the NFP program. To ensure that nurses are confident and able to dispense hormonal contraceptives, training, clinical protocols, consultation, and logistical support are needed.
- Estrogen in Cardiovascular Disease during Systemic Lupus Erythematosus. [REVIEW]
- Clin Ther 2014 Sep 3.
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that disproportionately affects women during their childbearing years. Cardiovascular disease is the leading cause of mortality in this patient population at an age when women often have low cardiovascular risk. Hypertension is a major cardiovascular disease risk factor, and its prevalence is markedly increased in women with SLE. Estrogen has traditionally been implicated in SLE disease progression because of the prevalence of the disease in women; however, its role in cardiovascular risk factors such as hypertension is unclear. The objective of this review is to discuss evidence for the role of estrogen in both human and murine SLE with emphasis on the effect of estrogen on cardiovascular risk factors, including hypertension.PubMed was used to search for articles with terms related to estradiol and SLE. The references of retrieved publications were also reviewed.The potential permissive role of estrogen in SLE development is supported by studies from experimental animal models of lupus in which early removal of estrogen or its effects leads to attenuation of SLE disease parameters, including autoantibody production and renal injury. However, data about the role of estrogens in human SLE are much less clear, with most studies not reaching firm conclusions about positive or negative outcomes after hormonal manipulations involving estrogen during SLE (ie, oral contraceptives, hormone therapy). Significant gaps in knowledge remain about the effect of estrogen on cardiovascular risk factors during SLE. Studies in women with SLE were not designed to determine the effect of estrogen or hormone therapy on blood pressure even though hypertension is highly prevalent, and risk of premature ovarian failure could necessitate use of hormone therapy in women with SLE. Recent evidence from an experimental animal model of lupus found that estrogen may protect against cardiovascular risk factors in adulthood. In addition, increasing evidence suggests that estrogen may have distinct temporal effects on cardiovascular risk factors during SLE.Data from experimental models of lupus suggest that estrogens may have an important permissive role for developing SLE early in life. However, their role in adulthood remains unclear, particularly for the effect on cardiovascular disease and its risk factors. Additional work is needed to understand the effect of estrogens in human SLE, and preclinical studies in experimental models of SLE may contribute important mechanistic insight to further advance the field.
- 50 years of hormonal contraception-time to find out, what it does to our brain. [Journal Article]
- Front Neurosci 2014.:256.
Hormonal contraceptives are on the market for more than 50 years and used by 100 million women worldwide. However, while endogenous steroids have been convincingly associated with change in brain structure, function and cognitive performance, the effects of synthetic steroids contained in hormonal contraceptives on brain and cognition have barely been investigated. In this article we summarize the sparse findings, describing brain structural, functional and behavioral findings from the literature and suggest that synthetic steroids may contribute to masculinizing as well as feminizing effects on brain and behavior. We try to identify methodological challenges, explain, how results on endogenous steroids may transfer into research on hormonal contraceptives and point out factors that need to be controlled in the study of hormonal contraceptive dependent effects. We conclude that there is a strong need for more systematic studies, especially on brain structural, functional and cognitive changes due to hormonal contraceptive use. The hormonal contraceptive pill is the major tool for population control. Hence, such behavioral changes could cause a shift in society dynamics and should not stay unattended.
- Normal breast physiology: the reasons hormonal contraceptives and induced abortion increase breast-cancer risk. [Journal Article]
- Issues Law Med 2014; 29(1):135-46.
A woman gains protection from breast cancer by completing a full-term pregnancy. In utero, her offspring produce hormones that mature 85 percent of the mother's breast tissue into cancer-resistant breast tissue. If the pregnancy ends through an induced abortion or a premature birth before thirty-two weeks, the mother's breasts will have only partially matured, retaining even more cancer-susceptible breast tissue than when the pregnancy began. This increased amount of immature breast tissue will leave the mother with more sites for cancer initiation, thereby increasing her risk of breast cancer. Hormonal contraceptives increase breast-cancer risk by their proliferative effect on breast tissue and their direct carcinogenic effects on DNA. Hormonal contraceptives include estrogen-progestin combination drugs prescribed in any manner of delivery: orally, transdermally, vaginally, or intrauterine. This article provides the detailed physiology and data that elucidate the mechanisms through which induced abortion and hormonal contraceptives increase breast-cancer risk.