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Lazorwitz A, Sheeder J, Teal S. The effect of rifampin on serum etonogestrel concentrations and biomarkers of ovulation among contraceptive implant users: A pharmacokinetic and pharmacodynamic study. Contraception 2023; 123:110035. [PMID: 36997081 PMCID: PMC10461170 DOI: 10.1016/j.contraception.2023.110035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Rifampin, a strong CYP3A inducer, is the gold standard for evaluating CYP3A-mediated drug-drug interactions. We aimed to evaluate the pharmacokinetic and pharmacodynamic effects of a short course (2 weeks) of rifampin on serum etonogestrel (ENG) concentrations and serologic measures of ovarian activity (endogenous estradiol [E2] and progesterone [P4]) among ENG implant users. STUDY DESIGN We enrolled healthy females using ENG implants for 12 to 36 months. We measured baseline serum ENG concentrations using a validated liquid chromatography mass-spectrometry assay and baseline E2 and P4 concentrations using chemiluminescent immunoassays. After 2 weeks of rifampin 600 mg daily, we repeated ENG, E2, and P4 measurements. We compared pre- and post-rifampin serum measurements using paired Wilcoxon signed-rank tests. RESULTS Fifteen participants completed all study procedures. Participants' median age was 28.2 years (range 21.8-34.1), median body-mass index was 25.2 kg/m2 (range 18.9-37.3), and median duration of implant use was 22 months (range 12-32). All participants experienced significant decreases from baseline ENG concentrations (median 164.0 pg/mL [range 94.4-265.0]) to post-rifampin measurements (median 47.8 pg/mL [range 24.7-82.8]) (p < 0.001). Serum E2 concentrations also significantly increased with rifampin exposure (median 73 pg/mL vs 202 pg/mL, p = 0.003); increases in serum P4 concentrations were not statistically significant (p = 0.19). Three participants (20%) experienced increased luteal activity, with one presumptively ovulating post-rifampin (P4 = 15.8 ng/mL). CONCLUSIONS With only short exposure to a strong CYP3A inducer, ENG implant users experienced clinically significant decreases in serum ENG concentrations that led to changes in biomarkers indicative of waning suppression of ovulation. IMPLICATIONS Even a short, 2-week course of treatment with rifampin places etonogestrel contraceptive implant users at risk for decreased contraceptive efficacy. Clinicians should counsel patients using etonogestrel implants considering any duration of rifampin therapy on the need for backup nonhormonal contraception or the use of an intrauterine device to avoid unintended pregnancies.
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Affiliation(s)
- Aaron Lazorwitz
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Stephanie Teal
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
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Abstract
PURPOSE OF REVIEW To review the current literature on the multiple types and uses of progestins in reproductive healthcare. RECENT FINDINGS Progestins for contraceptive use are available in multiple forms, with the ongoing development of transdermal, intravaginal, and male contraception formulations. Noncontraceptive use of progestins often overlaps with contraceptive indications, which allows for simultaneous multipurpose progestin use, especially in reproductive-aged patients. More studies are needed to determine contraceptive doses of progestins used for noncontraceptive purposes. Side effect profiles of progestins are dependent on their formulation and cross-reactivity with other steroid receptors. Development of newer progestins includes manipulating pharmacologic properties to avoid undesired side effects. SUMMARY Progestins have multiple uses in reproductive healthcare, including contraception, menstrual suppression, endometrial protection, and hormonal replacement therapy. The development of progestins for these indications can expand therapy for people with contraindications to estrogen-based hormonal therapy.
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Glasier A, Edelman A, Creinin MD, Han L, Matulich MC, Brache V, Westhoff CL, Hemon A. Mechanism of action of norgestrel 0.075 mg a progestogen-only pill. I. Effect on ovarian activity. Contraception 2022; 112:37-42. [PMID: 35351445 DOI: 10.1016/j.contraception.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the effect on ovarian activity and ovulation of 28 days of correct daily use of a progestogen-only pill containing norgestrel 0.075 mg. STUDY DESIGN We performed a prospective, randomized, cross-over study at two US sites, recruiting healthy women of reproductive age to use norgestrel 0.075 mg daily for three 28-day treatment cycles. We monitored ovarian activity every 3-4 days with reproductive hormone measurements and ovarian ultrasonography. Participants recorded pill use in daily diaries. An adjudication committee independent of the research sites assessed ovarian activity using a modified Hoogland score combining hormone concentrations and follicle diameter and appearance (quiescence 1-3, ovarian activity without ovulation 4-5, and ovulatory/postovulatory 6-7). RESULTS We report here the findings of the initial 28-day treatment cycle in which 51/52 recruited participants provided data sufficient for analysis. Two thirds of subjects had no evidence of ovulation (34/51, 66.6%); eight of these (15.7%) had quiescent ovaries (follicle <13 mm diameter) and 26 (51%) had follicular development (follicle >13 mm diameter) without ovulation. Seventeen participants ovulated, of whom 12 (23.5%) had a normal, and 5 (9.8%) an abnormal luteal phase. Persistent ovarian follicles were common among women who had ovarian activity without ovulation, 17/26 participants (65.4%) had a large follicle which persisted beyond 28 days. CONCLUSION During 28 days of exposure to a norgestrel 0.075 mg progestogen-only pill, most women had no evidence of ovulation. IMPLICATIONS Ovulation inhibition and follicle growth disturbance are important in the mechanism of action of a progestogen-only pill containing norgestrel 0.075 mg.
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Affiliation(s)
- Anna Glasier
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Alison Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Leo Han
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Melissa C Matulich
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Vivian Brache
- Asociación Dominicana Pro Bienestar de la Familia, Inc. (PROFAMILIA), Santo Domingo, Dominican Republic
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Bastianelli C, Farris M, Rosato E, Varliero F, Del Savio MC, Facchinetti F, Grandi G. The use of different doses levonorgestrel-releasing intrauterine system (LNG-IUS): real-world data from a multicenter Italian study. EUR J CONTRACEP REPR 2021; 27:16-22. [PMID: 34528867 DOI: 10.1080/13625187.2021.1975269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Current research fails to adequately inform about the differential use of available levonorgestrel-releasing intrauterine systems (LNG-IUSs) in real life. Aim of our study was to compare the characteristics, satisfaction, continuation rates, and adverse effects between users of the high-dose LNG-IUS (52 mg) and of the low dose LNG-IUS (13.5 mg and 19.5 mg). MATERIALS AND METHODS A prospective cohort study was performed in two Services for Family Planning in normal menstruating women with the inclusion of all new prescriptions of LNG-IUS for contraception. Women were followed for a mean of 9.1 ± 2.6 months after placement. RESULTS 109 women (mean age of 39.8 ± 8.7 years old) were included, 69.7% using a high dose LNG-IUS and 30.3% using a low dose LNG-IUS. Women with a low dose LNG-IUS were significantly younger, thinner, more nulliparous, with fewer vaginal deliveries and C-sections, with a lower menstrual flow length and with more previous use of short-acting reversible contraceptives (p < 0.05). LNG-IUS continuation was similar and very high at the last follow-up: 100 vs. 94.7% in the low and high dose LNG-IUS groups, respectively (p = 0.18). Satisfaction with treatment at the end of the study was similar between different LNG-IUS doses (p = 0.85), with 78.9% being satisfied/very satisfied. Bleeding patterns were significantly different between the two LNG-IUS doses (p < 0.0001). Diagnosis of dysfunctional cysts was more frequent in women with high dose compared to low dose LNG-IUS (22.2 vs. 12.1%), albeit not significantly. CONCLUSIONS We have shown a clear differential use of available LNG-IUS in clinical practice, both as baseline characteristics and as different outcomes, primarily for bleeding patterns. However, all these systems were associated with a very high rate of satisfaction and continuation.
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Affiliation(s)
- Carlo Bastianelli
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Manuela Farris
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Elena Rosato
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Federico Varliero
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Maria Chiara Del Savio
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Safety and Benefits of Contraceptives Implants: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:ph14060548. [PMID: 34201123 PMCID: PMC8229462 DOI: 10.3390/ph14060548] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.
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Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health 2021; 18:4. [PMID: 33407632 PMCID: PMC7788930 DOI: 10.1186/s12978-020-01054-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/06/2020] [Indexed: 01/16/2023] Open
Abstract
Background Unintended pregnancies (UIP) have a significant impact on health of women and the health budget of countries. Contraception is an effective way to prevent UIPs. The study objective was to collate evidence on clinical effectiveness of etonogestrel subdermal implant (ESI), continuation rate and side effect profile among eligible women of reproductive age group, as compared to levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (Cu-IUD) and depot medroxy progesterone acetate injections; other types of contraceptive implants were excluded as comparators. Methods The protocol of the systematic review was registered in Prospero (registration number: CRD42018116580). MEDLINE via PubMed, Cochrane library and web of science were the electronic databases searched. A search strategy was formulated and studies from 1998 to 2019 were included. Clinical trial registries and grey literature search was done. Critical assessment of included studies was done using appropriate tools. A qualitative synthesis of included studies was done and a meta-analysis was conducted in RevMan software for continuation rates of ESI as compared to other long acting reversible contraceptives (LARC) e.g. LNG IUS and Cu-IUD. Results The search yielded 23,545 studies. After excluding 467 duplicates, 23,078 titles were screened and 51 studies were included for the review. Eight of the 15 studies reporting clinical effectiveness reported 100% effectiveness and overall pearl index ranged from 0 to 1.4. One-year continuation rates ranged from 57–97%; 44–95% at the end of second year and 25–78% by 3 years of use. Abnormal menstruation was the most commonly reported side effect. There was no significant difference in bone mineral density at 1 year follow-up. The meta-analyses showed that odds ratio (OR) of 1-year continuation rate was 1.55 (1.36, 1.76) for LNG-IUS vs. ESI and 1.34 (1.13, 1.58) for copper-IUD vs. ESI; showing that continuation rates at the end of one-year were higher in LNG-IUS and copper-IUD as compared to ESI. Conclusion ESI is clinically effective and safe contraceptive method to use, yet 1-year continuation rates are lower as compared to LNG-IUS and copper-IUD, mostly attributed to the disturbances in the menstruation.
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Affiliation(s)
- Kusum V Moray
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Himanshu Chaurasia
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Health Technology Assessment Secretariat, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Beena Joshi
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
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Best Practices for Counseling Adolescents about the Etonogestrel Implant. J Pediatr Adolesc Gynecol 2020; 33:448-454. [PMID: 32621879 DOI: 10.1016/j.jpag.2020.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 01/11/2023]
Abstract
Among young persons, ease of use, high efficacy, and high acceptability makes the etonogestrel contraceptive implant an important choice for this age group. Adolescent-friendly, patient-centered counseling considers the patient's cognitive development, the influence of friends and family, as well as their own preferences and values. Age-appropriate language, graphics, and models are useful to explain contraceptive options and relevant side effects. Effectiveness, reversibility, safety, noncontraceptive benefits, and side effects are important attributes and should be discussed when teens are choosing a contraceptive method. In this review we describe suggested best practices for counseling adolescents about the etonogestrel implant so they can make informed, prudent decisions about using this contraceptive method.
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Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol 2019; 66:28-40. [PMID: 32014434 DOI: 10.1016/j.bpobgyn.2019.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023]
Abstract
Unplanned pregnancy (UP) is a public health problem, which affects millions of women worldwide. Providing long-acting reversible contraceptive (LARC) methods is an excellent strategy to avoid or at least reduce UP, because the effectiveness of these methods is higher than other methods, and is indeed comparable to that of permanent contraception. As the initial introduction of the inert plastic intrauterine device (IUD) and of the six-rod implant, pharmaceutical companies have introduced a copper IUD (Cu-IUD), different models of levonorgestrel-releasing intrauterine system (LNG IUS), and one and two-rod implants, which certainly improved women's LARC options. The main characteristic of LARCs is that they provide high contraceptive effectiveness with a single intervention, and that they can be used for a long time. Emerging evidence from the last few years has demonstrated that it is possible to extend the use of the 52 mg LNG IUS and of the etonogestrel-implant beyond five- and three years, respectively, which adds new value to these LARCs.
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Abstract
To reduce the rate of unintended pregnancies, patients should select a contraceptive option that fits their needs and lifestyle. Long-acting reversible contraceptives (LARCs) are a relatively safe and effective option. This article outlines the characteristics of available LARCs and identifies the appropriate method for specific patient populations.
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Geoffron S, Cohen J, Sauvan M, Legendre G, Wattier JM, Daraï E, Fernandez H, Chabbert-Buffet N. [Endometriosis medical treatment: Hormonal treatment for the management of pain and endometriotic lesions recurrence. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530557 DOI: 10.1016/j.gofs.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.
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Affiliation(s)
- S Geoffron
- Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Cohen
- Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), UMR-S938 Inserm, Sorbonne université, 75012 Paris, France
| | - M Sauvan
- Service de gynecologie-obstetrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France
| | - G Legendre
- Service de gynecologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-INSERM, U1018, équipe 7, genre, sante sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France
| | - J M Wattier
- Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France
| | - E Daraï
- Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), UMR-S938 Inserm, Sorbonne université, 75012 Paris, France
| | - H Fernandez
- Service de gynecologie-obstetrique, CHU de Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge : VIH, reproduction, pédiatrie, université Paris Sud, 94800 Villejuif, France
| | - N Chabbert-Buffet
- Service de gynecologie-obstetrique et medecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre expert en endométriose (C3E), UMR-S938 Inserm, Sorbonne université, 75012 Paris, France.
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Geoffron S, Legendre G, Daraï E, Chabbert-Buffet N. [Medical treatment of endometriosis: Hormonal treatment of pain, impact on evolution and future perspectives]. Presse Med 2017; 46:1199-1211. [PMID: 29133081 DOI: 10.1016/j.lpm.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Endometriosis is a chronic painful disease, for which hormone therapy is usually offered as a first line option to women not willing to conceive. OBJECTIVES To analyse and synthesize the literature, from 2006 onwards, on pain control, and disease evolution in oemn using combined hormonal contraceptives, progestins and GnRH analogs. Data on other current and future treatment perspectives is included as well. SOURCES Medline (Pubmed), the Cochrane Library, and endometriosis treatment recommendations published by European Society of Human Reproduction and Embryology (ESHRE), National Institute for health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG), Royal College of Obstetricians and Gynaecologists (RCOG) and Société des Obstétriciens et Gynécologues du Canada (SOGC). STUDY SELECTION Meta-analysis and clinical trials are included. RESULTS Study quality is heterogeneous in general. Hormone therapy inconstantly allows pain relief and prevention of endometrioma and rectovaginal wall nodules recurrence. Available molecules and routes of administration as well as risk benefit balance are evaluated. Data on future perspectives are limited to date and do not allow use in routine. CONCLUSION Hormonal treatment of endometriosis relies on combined hormonal contraceptives (using different routes of administration), progestins and particularly the levonorgestrel-releasing IUS, and GnRH analogs as a last option, in combination with an add-back therapy. Promising alternatives are currently under preclinical and clinical evaluation.
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Affiliation(s)
- Sophie Geoffron
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France
| | - Guillaume Legendre
- CHU d'Angers, service de gynécologie-obstétrique, 49000 Angers, France; Université Paris Sud, CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, 75000 Paris, France
| | - Emile Daraï
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France; AP-HP, hôpital Tenon, centre expert en endométriose (C3E), 75020 Paris, France; UPMC, groupe de recherche clinique GRC-6, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France; AP-HP, hôpital Tenon, centre expert en endométriose (C3E), 75020 Paris, France; UPMC, groupe de recherche clinique GRC-6, 75020 Paris, France.
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Critical Review: Mechanisms of HIV Transmission in Depo-Provera Users: The Likely Role of Hypoestrogenism. J Acquir Immune Defic Syndr 2016; 71:1-7. [PMID: 26761267 DOI: 10.1097/qai.0000000000000805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Almost half of new HIV infections worldwide occur in women, and vaginal intercourse is the most common mode of transmission. Accumulating evidence suggests that depot medroxyprogesterone acetate may increase HIV transmission, but little is known about the underlying mechanisms. We propose that hypoestrogenism in depot medroxyprogesterone acetate may contribute to increased HIV transmission. We present supportive evidence and propose potential interventions to prevent or treat vaginal hypoestrogenism using vaginal estrogens.
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman W, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. Canadian Contraception Consensus (Part 3 of 4): Chapter 8 - Progestin-Only Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:279-300. [PMID: 27106200 DOI: 10.1016/j.jogc.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. OUTCOMES Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the relative cost and availability of cited contraceptive methods in Canada. EVIDENCE Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis in incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). CHAPTER 8: PROGESTIN-ONLY CONTRACEPTION: Summary Statements Recommendations.
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. Consensus canadien sur la contraception (3e partie de 4) : chapitre 8 – contraception à progestatif seul. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:301-26. [DOI: 10.1016/j.jogc.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weisberg E, Fraser IS. Contraception and endometriosis: challenges, efficacy, and therapeutic importance. Open Access J Contracept 2015; 6:105-115. [PMID: 29386928 PMCID: PMC5683134 DOI: 10.2147/oajc.s56400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endometriosis is a benign gynecological condition that is estimated to affect 10% of women in the general population and appears to be increasing in incidence. It is an estrogen-dependent inflammatory disease, and is primarily characterized by dysmenorrhea, deep dyspareunia, chronic pelvic pain, and variable effects on fertility. The symptoms may greatly affect quality of life, and symptom control may be the primary aim of initial management, while contraceptive effect is often secondary. It is estimated that 30%–50% of women with endometriosis have an infertility problem, so a considerable number of endometriosis sufferers will require effective, planned contraception to maximize “protection of fertility” and prevent progression of the endometriotic condition. Ideally, this contraception should also provide symptom relief and improvement of physical, mental, and social well-being. At the present time, long-term progestogens appear to be the most effective choice for meeting all of these requirements, but other options need to be considered. It is becoming increasingly recognized that hormonal contraceptive systems are necessary for prevention of disease recurrence following surgical treatment of endometriosis. The personal preferences of the woman are an integral part of the final contraceptive choice. This article discusses the advantages and disadvantages of the contraceptive options available to women with endometriosis.
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Affiliation(s)
| | - Ian S Fraser
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Ovarian cysts: presence and persistence with use of a 13.5mg levonorgestrel-releasing intrauterine system. Contraception 2015; 91:412-7. [DOI: 10.1016/j.contraception.2015.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/22/2022]
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López-Olmos J. Dispositivo intrauterino liberador de levonorgestrel (DIU Mirena®) y quistes de ovario. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2012.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
INTRODUCTION Although the contraceptive options for women have expanded considerably in the last decade, these methods are often not being offered to women as choices because clinicians are not well informed, limiting the ability of women to control their fertility. AREAS COVERED Areas covered include the use of oestradiol instead of ethinyl oestradiol and improved progestogens utilised in hormonal contraceptives, and new delivery systems have enabled the development of long-acting methods, which require less action on the part of the user, and thereby, reduce failure rates. Effective emergency contraceptive methods have become more readily available over the counter. However, male contraception, despite much research, still remains elusive. EXPERT OPINION This manuscript will provide an assessment of recent advances and controversies in contraception and make suggestions about improved availability.
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Affiliation(s)
- Edith Weisberg
- University of Sydney, Department of Obstetrics, Gynaecology and Neonatology , Camperdown, Sydney 2006 , Australia ,
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Mimoun C, Fritel X, Fauconnier A, Deffieux X, Dumont A, Huchon C. [Epidemiology of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:722-9. [PMID: 24210235 DOI: 10.1016/j.jgyn.2013.09.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ovarian cysts presumed benign can be organic or functional. Their prevalence is estimated between 14 and 18% in postmenopausal women and around 7% in asymptomatic women of childbearing age. Their incidence during pregnancy is between 0.2 and 5% and varies within the term of pregnancy. Ovarian cysts presumed benign have caused nearly 45,000 hospitalizations in France in 2012, bringing the annual risk of hospitalization for a woman residing in France to 1.3‰. Among the risk factors studied in the literature, tamoxifen increases the incidence of ovarian cysts in premenopausal patients and immunosuppressive treatments are associated with a high prevalence of benign ovarian cysts while estrogen contraception reduces the risk of developing functional cysts.
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Affiliation(s)
- C Mimoun
- Service de gynécologie et obstétrique, CHI Poissy-Saint-Germain, université Versailles-Saint-Quentin en Yvelines, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
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Subdermale kontrazeptive Implantate. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-012-0536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hartman LB, Monasterio E, Hwang LY. Adolescent contraception: review and guidance for pediatric clinicians. Curr Probl Pediatr Adolesc Health Care 2012; 42:221-63. [PMID: 22959636 DOI: 10.1016/j.cppeds.2012.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/11/2012] [Accepted: 05/23/2012] [Indexed: 01/19/2023]
Abstract
The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.
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Affiliation(s)
- Lauren B Hartman
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
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Bhatia P, Nangia S, Aggarwal S, Tewari C. Implanon: subdermal single rod contraceptive implant. J Obstet Gynaecol India 2011; 61:422-5. [PMID: 22851825 DOI: 10.1007/s13224-011-0066-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 02/09/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Study was conducted to determine acceptability, efficacy, safety, return of fertility with Implanon. METHODS Volunteers having regular menstruation, requiring spacing formed study population. Implanon was inserted within 5 days of LMP or concurrent with MTP. Woman was asked to record bleeding pattern, side effects. Implanon duration was 3 years but Implanon was removed before, if patient wanted pregnancy/for side effects. Subjects who did not adopt family planning method after removal were followed up for return of ovulation and pregnancy. RESULTS 200 subjects were enrolled (160 within 5 days of LMP, 40 concurrent with MTP). 74 implanon removals were done. (16 after tenure completion, 58 for other reasons.) 16% cases discontinued implanon for polymenorrhagia, 10% for irregular bleeding, 4.5% for amenorrhea. There was no failure of implanon. 40% had return of ovulation within one month, 95.8% conceived within 12 months. CONCLUSIONS Implanon is safe, effective, well accepted method of contraception.
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Casey PM, Long ME, Marnach ML, Bury JE. Bleeding related to etonogestrel subdermal implant in a US population. Contraception 2011; 83:426-30. [DOI: 10.1016/j.contraception.2010.09.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/16/2010] [Accepted: 09/27/2010] [Indexed: 11/25/2022]
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Pregnane progestin contraception in systemic lupus erythematosus: a longitudinal study of 187 patients. Contraception 2011; 83:229-37. [DOI: 10.1016/j.contraception.2010.08.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 08/23/2010] [Accepted: 08/23/2010] [Indexed: 11/19/2022]
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Lortlar N, Kilic S, Peker T, Zulfikaroglu E, Omeroglu S, Erbas D, Celik HH, Kormaz A, Tatar I. The long-term effects of progesterone-only contraceptives on endometrium and ovary in rats. Arch Gynecol Obstet 2010; 281:1051-9. [DOI: 10.1007/s00404-010-1356-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/05/2010] [Indexed: 11/24/2022]
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Bibliography. Current world literature. Minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2007; 19:402-5. [PMID: 17625426 DOI: 10.1097/gco.0b013e3282ca75fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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