CONTRACEPTIVES HORMONAL [keywords]
- Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods. [JOURNAL ARTICLE]
- Int J Gynaecol Obstet 2016 May 31.
To evaluate neurologists' knowledge of contraceptive counseling for women receiving antiepileptic drugs (AEDs).An interview-based survey was conducted from February 2 to June 30, 2015, among neurologists working in Ribeirão Preto, Brazil. Direct interviews were conducted using a questionnaire that assessed knowledge of the pharmacological interactions between various contraceptive methods and six AEDs (carbamazepine, phenobarbital, topiramate, phenytoin, lamotrigine, and valproate) on the basis of WHO medical eligibility criteria for contraceptive use.Among 42 neurologists who participated, 32 (76%) stated that they treated women with epilepsy and provided them with counseling for family planning. Overall, 34 (81%) recommended the use of a copper intrauterine device irrespective of the AED used, and 26 (60%) stated that they co-prescribed AEDs and hormonal contraceptives. Although 39 (93%) neurologists had knowledge that AEDs might contraindicate the use of some contraceptives, their knowledge regarding the specific drug interactions was lacking. Furthermore, 34 (81%) had no knowledge of WHO medical eligibility criteria for contraceptive use.Although most neurologists interviewed had knowledge of interactions between AEDs and hormonal contraceptives, they did not know which specific AEDs interacted with these agents.
- Adolescent endometriosis. [JOURNAL ARTICLE]
- Eur J Obstet Gynecol Reprod Biol 2016 Jun 16.
Endometriosis is a common finding in adolescents who have a history of chronic pelvic pain or dysmenorrhoea resistant to medical treatment, however the exact prevalence is unknown. Both early/superficial and advanced forms of endometriosis are found in adolescents, including ovarian endometriomas and deep endometriotic lesions. Whilst spontaneous resolution is possible, recent reports suggest that adolescent endometriosis can be a progressive condition, at least in a significant proportion of cases. It is also claimed that deep endometriosis has its roots in adolescence. Optimum treatment is far from clear and long term recurrence is still a significant problem. The most frequently reported treatment approach in the published literature is a combination of surgery and postoperative hormonal treatment with the combined oral contraceptives, progestins, levonorgestrel intrauterine system or gonadotrophin releasing hormone analogues. Use of gonadotrophin releasing hormone analogues and long term progestins should be carefully considered due to concerns over continuing bone formation in this age group. There is currently no consensus as to whether surgery should be avoided as much as possible to prevent multiple operations in the long term, or surgical treatment should be considered at an early stage before more severe lesions develop. Further research is required to determine which approach would offer a better long term outcome.
- Prevalence of combined contraceptive vaginal rings in Norway. [JOURNAL ARTICLE]
- Acta Obstet Gynecol Scand 2016 Jun 22.
Little is known about vaginal ring (VR) prescribers and user patterns in Norway and internationally. With data from the Norwegian Prescription Database, we explore user and prescriber characteristics of women initiating VR use.In a cross-sectional study design, we analyzed 47 127 first-time VR users starting from January 1(st) 2006 to December 31(st) 2012. Follow-up ended June 30(th) , 2013. We applied strict definitions for switching from any other hormonal contraceptive prior to and at the end of VR use. All analyses were done in SPSS, with chi-square test, t-test, and survival analysis.At study end, the prevalent use of VR reached 10 per 1000 women at fertile age, which amounted to 3% of all hormonal contraceptive use. The number of first-time VR users increased from 2006 to 2008 only among women under the age of 20. Nearly three out of four new users discontinued after three months. Physicians without specialist status and general practitioners accounted for over 70% of the prescriptions, whereas gynecologists accounted for 17% of the prescriptions. Gynecologists were significant prescribers of VR to women aged 35 or more.Gynecologists are important providers of VR to first-time users above 30 years of age. When prescribing VR to first-time users, it is important to discuss the need for contraception in a longer time perspective. Authorizing public health nurses/midwives as VR prescribers to teenagers, from 1 March 2006, may explain the relative increase in VR usage at a younger age. This article is protected by copyright. All rights reserved.
- Do BRCA1/2 mutation carriers have an earlier onset of natural menopause? [JOURNAL ARTICLE]
- Menopause 2016 Jun 20.
It has been hypothesized that BRCA1/2 mutation carriers have an earlier age at natural menopause (ANM), although to date findings are inconclusive. This study assessed the influence of BRCA mutation status on ANM, and aimed to explore the reasons of inconsistency in the literature.Cross-sectional assessment from an ongoing nationwide cohort study among members of BRCA1/2 mutated families. Information was obtained by a standardized questionnaire. Kaplan-Meier curves were constructed, and Cox regression was used to assess the association between BRCA1/2 mutation status and ANM. Adjustments were made for birth cohort, family, smoking, use of hormonal contraceptives, and parity.A total of 1,208 BRCA1/2 mutation carriers and 2,211 proven noncarriers were included. Overall, no association was found between BRCA1/2 mutation status and ANM (adjusted hazard ratio [HR] = 1.06 [95% CI, 0.87-1.30]). We examined if the null finding was due to informative censoring by uptake of risk-reducing salpingo-oophorectomy. Indeed, within the oldest birth cohort, in which the percentage of surgical menopause events was lowest and comparable between carriers and noncarriers, the HR for earlier natural menopause in carriers was 1.45 (95% CI, 1.09-1.94). The second oldest birth cohort, however, demonstrated a decreased HR (0.67 [95% CI, 0.46-0.98]), and thus no trend over birth cohorts was found.Various types of selection bias hamper the comparison of ANM between BRCA1/2 mutation carriers and noncarriers, genetically tested in the clinic.
- Sex hormone-binding globulin and thrombin generation in women using hormonal contraception. [JOURNAL ARTICLE]
- Biomarkers 2016 Jun 21.:1-15.
We investigated the impact of serum sex hormone-binding globulin (SHBG) on thrombin generation (TG) in women according to hormonal contraception.A cross-sectional study of SHBG and TG measured via calibrated automated thrombography was conducted in 150 healthy women, including 75 users of combined oral contraceptives (COC), 22 users of progestin-only contraceptives (POC) and 53 non-users.COC but not POC-users had significantly higher SHBG levels compared with non-users. In hormonal contraceptive users, SHBG was positively associated with both activated protein C resistance and baseline TG, and protein S and prothrombin were important mediators.These data provide further evidence that SHBG may be used as a biomarker in assessing prothrombotic profile of hormonal contraception.
- EFFECT OF HORMONAL CONTRACEPTIVES ON SERUM SEROTONIN IN FEMALES OF REPRODUCTIVE AGE GROUP. [Journal Article]
- J Ayub Med Coll Abbottabad 2016 Jan-Mar; 28(1):56-8.
Many types of hormonal contraceptives are in use nowadays for example oral pills, emergency contraceptive pills, vaginal rings, implantable rods and injectable contraceptives (combined and progestogens only). The purpose of this study was to determine and compare serum serotonin levels in married fertile females of reproductive age group using hormonal contraceptives with non-contraceptive users.A total of 300 women were selected in the study. This cross sectional study included three groups; Group-1 (control), group-2 (combined oral contraceptive users) and group-3 (injectable contraceptive users). History and examination of subjects were recorded on pro forma. Levels of serum serotonin were measured using standard ELISA kits. Results were analysed by one way ANOVA and a p-value 0.05% was taken as significant, using SPSS 16.0.The mean age of the patients in group-1 was 30.4 ± 6.1 years, group-2 was 28.9 ± 4.9 and in group-3 was 2.5 ± 6.8 years. For subjects in group-1, group-2 and group 3 the mean ± SD concentration of serum serotonin was 160.68 ± 53.27 ng/dl, 227.3 ± 63.98 ng/dl and 118.19 ± 31.32 ng/dl. A significant (p = 0.00) difference was seen among three groups, i.e., group-1, group-2 and group-3. After applying Post HOC Tukey's HSD, there was statistically no significant difference between group-1 and group-2 (p = 0.956). Difference was seen between group-2 and group-3 (p = 0.00), it was also significant between group-3 and group-1 (p = 0.00).It was concluded that hormonal contraceptives affect the levels of serum serotonin.
- [Myths and realities of the long-term reversible contraceptives]. [English Abstract, Journal Article]
- Ginecol Obstet Mex 2015 Nov; 83(11):707-21.
For a woman uses contraception acceptance not only required but also the possibility of minimal or no side effects, comfort and tranquility of their safety. There are women who find it inconvenient not taking the pill daily, but for many other yes, what follows that notwithstanding their safety, do not suit the need of women. IUDs have reached high fees clinical efficacy and safety for use in any group of women, including gilts.A search for original articles and systematic reviews published in the last ten years in the PubMed database, specifically study reversible long-term hormonal contraception was made. They were included in the various search engines, the words: Long-Acting Reversible Contraception, intrauterine contraceptive method, contraceptive implants and intrauterine, myths About IUDs, and others. We selected the highest level of evidence and documents were analyzed and 76 of these myths and realities were located around the long-term contraception.There are too many myths accepted as paradigms and perceptions about IUDs, especially about its indication to nulliparous women, who do not stand by the scientific evidence. The clinical efficacy of intrauterine contraception in nulliparous women is equal in multiparous; though probably more painful insertion in the former, but not harder.
- Molecular architecture of the human sperm IZUMO1 and egg JUNO fertilization complex. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- Nature 2016 Jun 23; 534(7608):562-5.
Fertilization is an essential biological process in sexual reproduction and comprises a series of molecular interactions between the sperm and egg. The fusion of the haploid spermatozoon and oocyte is the culminating event in mammalian fertilization, enabling the creation of a new, genetically distinct diploid organism. The merger of two gametes is achieved through a two-step mechanism in which the sperm protein IZUMO1 on the equatorial segment of the acrosome-reacted sperm recognizes its receptor, JUNO, on the egg surface. This recognition is followed by the fusion of the two plasma membranes. IZUMO1 and JUNO proteins are indispensable for fertilization, as constitutive knockdown of either protein results in mice that are healthy but infertile. Despite their central importance in reproductive medicine, the molecular architectures of these proteins and the details of their functional roles in fertilization are not known. Here we present the crystal structures of human IZUMO1 and JUNO in unbound and bound conformations. The human IZUMO1 structure exhibits a distinct boomerang shape and provides structural insights into the IZUMO family of proteins. Human IZUMO1 forms a high-affinity complex with JUNO and undergoes a major conformational change within its N-terminal domain upon binding to the egg-surface receptor. Our results provide insights into the molecular basis of sperm-egg recognition, cross-species fertilization, and the barrier to polyspermy, thereby promising benefits for the rational development of non-hormonal contraceptives and fertility treatments for humans and other mammals.
- Hormonal contraceptives: pharmacology tailored to women's health. [REVIEW, JOURNAL ARTICLE]
- Hum Reprod Update 2016 Jun 15.
In recent years, several new oral contraceptives have become available. In some ways, they represent an evolution in terms of individualization and compliance on the part of women. The new formulations make it increasingly possible to prescribe a specific hormonal contraceptive on an individual basis.A systematic literature search of PubMed was performed using the following combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptive'. Only English-language papers published between January 2000 and July 2014 were included in our analysis. The present review analyzes all aspects of the choice of oral contraceptives in the different phases of a woman's life in detail.Regarding the estrogen component, lowering the dose of ethinylestradiol (EE) helped reduce associated side effects. Natural estradiol is now available and represents a valid alternative to EE. And regarding progestins, the dose has changed over time, as well as the endocrine and metabolic characteristics. These are the fruit of much research into improvement of old products (19-nor-progesterone-derived progestins) with androgenic effects and testing of new molecules with improved metabolic neutrality in terms of insulin sensitivity and lipid parameters. New progestins were a genuine turning point because they greatly reduced major side effects, such as water retention, and their anti-androgenic properties made them indicated for all forms of hyperandrogenism associated with acne and mild hirsutism. The associations of estradiol/dienogest and estradiol/nomegestrol acetate are the most suitable contraceptives for women with abundant menstrual bleeding and can increase the number of potential users of hormonal contraception.Progress in the provision of new oral contraceptives has improved the risk/benefit ratio, by increasing benefits and reducing risks. The present challenge is to tailor contraceptives to individual needs in terms of efficacy and protection of reproductive health.
- Gender, Contraceptives and Individual Metabolic Predisposition Shape a Healthy Plasma Lipidome. [Journal Article]
- Sci Rep 2016.:27710.
Lipidomics of human blood plasma is an emerging biomarker discovery approach that compares lipid profiles under pathological and physiologically normal conditions, but how a healthy lipidome varies within the population is poorly understood. By quantifying 281 molecular species from 27 major lipid classes in the plasma of 71 healthy young Caucasians whose 35 clinical blood test and anthropometric indices matched the medical norm, we provided a comprehensive, expandable and clinically relevant resource of reference molar concentrations of individual lipids. We established that gender is a major lipidomic factor, whose impact is strongly enhanced by hormonal contraceptives and mediated by sex hormone-binding globulin. In lipidomics epidemiological studies should avoid mixed-gender cohorts and females taking hormonal contraceptives should be considered as a separate sub-cohort. Within a gender-restricted cohort lipidomics revealed a compositional signature that indicates the predisposition towards an early development of metabolic syndrome in ca. 25% of healthy male individuals suggesting a healthy plasma lipidome as resource for early biomarker discovery.