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Booyens RM, Engelbrecht AM, Strauss L, Pretorius E. To clot, or not to clot: The dilemma of hormone treatment options for menopause. Thromb Res 2022; 218:99-111. [PMID: 36030662 DOI: 10.1016/j.thromres.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022]
Abstract
Untreated menopause may have serious health implications, but treatments can have dangerous side effects. We evaluate menopausal symptoms as well as available treatments -the routes of administration and their effect on blood coagulation. Menopausal females may experience hot flushes, vulva- and vaginal atrophy and osteoporosis. Many treatments are available to relieve these symptoms such as Conjugated Equine Estrogen and bioidentical hormones. The routes of administration include oral and transdermal. Hormones that are administered orally undergo a hepatic first pass metabolism. The by-products have a lower efficacy and possibly enhanced side effects. Furthermore, hormone treatments influence the coagulation cascade through coagulation factors or their regulators. Increased coagulation poses a risk for venous thromboembolism. Currently a definite conclusion on whether the side effects from hormone treatments exceed the risk of untreated menopause cannot be made. However, a more individualised approach to hormone treatments may be the most feasible solution to this dilemma.
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Affiliation(s)
- Renata M Booyens
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Anna-Mart Engelbrecht
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Ledivia Strauss
- Functional Medicine Practice, A1 Polo Village Offices, Kliprug Minor Rd, Val De Vie Winelands Lifestyle Estate, 7646, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa.
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2
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Machin N, Ragni MV. Hormones and thrombosis: risk across the reproductive years and beyond. Transl Res 2020; 225:9-19. [PMID: 32599096 DOI: 10.1016/j.trsl.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
Endogenous and exogenous hormones have significant effects on coagulation and may tip the hemostatic balance toward thrombosis. The endogenous hormonal changes in pregnancy and polycystic ovary syndrome, and exogenous hormonal contraception, menopause replacement, and transgender cross-hormone replacement may increase thromboembolism risk. Using the lowest effective dose is critical for prevention, but once thrombosis occurs, anticoagulation may be required, in some, long term. We review the relative risk of thrombosis in these conditions, risk factors, and anticoagulation treatment and prevention. Implementation of lowest effective hormonal therapies, thrombosis reduction strategies, and current anticoagulation management are critical for optimal patient outcomes.
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Affiliation(s)
- Nicoletta Machin
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania
| | - Margaret V Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania.
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FSRH Guideline (April 2019) Overweight, Obesity and Contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-69. [PMID: 31053605 DOI: 10.1136/bmjsrh-2019-ooc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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4
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Fiascone S, Danilack VA, Kao MJ, Cohen M, Singh K, Kalife E, Luis C, Lokich E, DiSilvestro P, Robison K. While women await surgery for type I endometrial cancer, depot medroxyprogesterone acetate reduces tumor glandular cellularity. Am J Obstet Gynecol 2018; 219:381.e1-381.e10. [PMID: 30063901 DOI: 10.1016/j.ajog.2018.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple population-level studies have demonstrated an adverse effect of long wait times to surgery on survival for women with endometrial cancer. Other retrospective and nonrandomized prospective studies have shown that preoperative administration of depot medroxyprogesterone acetate decreases tumor glandular cellularity, which may be a surrogate marker for clinically meaningful tumor response. OBJECTIVE We sought to determine whether preoperative injection with depot medroxyprogesterone acetate decreases tumor glandular cellularity when compared to placebo injection in women awaiting hysterectomy for endometrial intraepithelial neoplasia or type I endometrial cancer, and to determine whether depot medroxyprogesterone acetate injection affects quality of life while waiting for surgery. STUDY DESIGN This was a double-blind, randomized controlled trial of 400-mg depot medroxyprogesterone acetate injection or 0.9% saline injection at the preoperative visit. Patients with recent use of progesterone analogs were excluded. A sample size of 76 patients (38 per arm) was calculated to detect a 20% difference in decreased glandular cellularity between arms. Pathologic characteristics including the primary outcome, tumor glandular cellularity, from patients' diagnostic biopsies were reviewed by 2 dedicated gynecologic pathologists and compared to posttreatment hysterectomy specimens. On the night prior to surgery, patients completed the Functional Assessment of Cancer Therapy-Endometrial Survey (Version 4) to report quality of life while waiting for surgery. In comparing characteristics between the intervention and control groups, t tests were used for continuous variables, and χ2 or Fisher exact tests were used where appropriate for categorical data. RESULTS From March 2015 through March 2016, 148 women were screened and 76 patients were enrolled. In all, 38 patients were randomized to and received depot medroxyprogesterone acetate injection and 38 were randomized to and received placebo injection. Demographics were similar between groups. Patients who received depot medroxyprogesterone acetate injection experienced a larger decrease in tumor glandular cellularity (mean change -64 [-31.8%] vs -14 [-5.5%] cells per quarter high-powered field in depot medroxyprogesterone acetate vs placebo groups, P = .002). This effect was most pronounced in women waiting ≥3 weeks for surgery. Several additional histologic and immunohistochemical markers of tumor differentiation and decreased cell proliferation were more pronounced in the depot medroxyprogesterone acetate group than in the placebo group. There were no significant differences in quality of life between groups on the Functional Assessment of Cancer Therapy-Endometrial Survey. Only 5.3% of patients who were approached declined to participate due to concerns regarding an intramuscular injection. CONCLUSION Administration of depot medroxyprogesterone acetate prior to surgery for type I endometrial cancers caused greater tumor effect than placebo injection. Injection of depot medroxyprogesterone acetate was acceptable to and well tolerated by patients. Depot medroxyprogesterone acetate may represent a meaningful bridge to surgery in women who can expect long wait times.
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Rocha ALL, Campos RR, Miranda MMS, Raspante LBP, Carneiro MM, Vieira CS, Reis FM. Safety of hormonal contraception for obese women. Expert Opin Drug Saf 2017; 16:1387-1393. [PMID: 28988524 DOI: 10.1080/14740338.2018.1389893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis. Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis. Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.
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Affiliation(s)
- Ana Luiza L Rocha
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Rayana R Campos
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Marina M S Miranda
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Laio B P Raspante
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Márcia M Carneiro
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Carolina S Vieira
- b Department of Gynecology and Obstetrics, Medical School of Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , Brazil.,c Population Council , New York , NY , USA
| | - Fernando M Reis
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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Melhado-Kimura V, Bizzacchi JMA, Quaino SKP, Montalvao S, Bahamondes L, Fernandes A. Effect of the injectable contraceptive depot-medroxyprogesterone acetate on coagulation parameters in new users. J Obstet Gynaecol Res 2017; 43:1054-1060. [DOI: 10.1111/jog.13306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/21/2016] [Accepted: 01/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Silmara Montalvao
- Blood Center, School of Medical Sciences; University of Campinas; Campinas SP Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology; University of Campinas; Campinas SP Brazil
| | - Arlete Fernandes
- Department of Obstetrics and Gynecology; University of Campinas; Campinas SP Brazil
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Dragoman MV, Gaffield ME. The safety of subcutaneously administered depot medroxyprogesterone acetate (104mg/0.65mL): A systematic review. Contraception 2016; 94:202-15. [PMID: 26874275 DOI: 10.1016/j.contraception.2016.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Depot medroxyprogesterone acetate (DMPA), a progestogen-only contraceptive injectable, has traditionally been formulated as a crystalline suspension delivered intramuscularly (IM) at a dose of 150mg/1.0mL. A new, lower dose formulation of DMPA (104mg/0.65mL) has been developed for subcutaneous administration (SC). Given its increasing global availability and public health relevance, DMPA-SC was prioritized for inclusion as a new method referenced in the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (MEC), 5th Edition. OBJECTIVE This systematic review evaluated the published peer-reviewed literature regarding the safety of DMPA-SC among women with various characteristics or medical conditions. Results of this review informed the decision-making of a WHO Guideline Development Group in order to include recommendations on contraceptive eligibility within the revised MEC. METHODS We searched PubMed and Cochrane Library databases to identify all relevant evidence published in peer-reviewed journals regarding the safety of DMPA-SC when used by women of reproductive age, particularly those with select characteristics or conditions specified in the MEC, from inception through June 2015. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force. RESULTS Fourteen studies met criteria for inclusion. Ten reported results relevant to DMPA users of varying age or with obesity, endometriosis or HIV; four compared the safety of DMPA-SC and DMPA-IM when used by general populations of healthy women. A randomized trial evaluating changes in bone mineral density among adult DMPA-SC and DMPA-IM users demonstrated no differences at 2years of follow-up. Limited evidence reported no consistent differences in weight change or bleeding patterns according to age; however, adolescents (<18years) were not included in any studies. Similar contraceptive efficacy, weight change, bleeding patterns and occurrence of other adverse effects among obese and nonobese DMPA-SC users were observed. Women with endometriosis using DMPA-SC over 6months had minimal decreases in bone mineral density, weight gain, few serious adverse events and experienced improved pain symptoms. Women living with HIV tolerated injection of DMPA-SC with rare complications. DMPA-SC and DMPA-IM also show therapeutic equivalence and similar effects on weight gain, changes in bleeding patterns and reports of other adverse effects when these different delivery systems were used by general populations of women. CONCLUSION Evidence for use of DMPA-SC by women with select conditions and characteristics including age, obesity, endometriosis or HIV demonstrates that this method can generally be used safely in these contexts. Further, DMPA-SC and DMPA-IM appear to be therapeutically equivalent with similar safety profiles when used by healthy women.
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Affiliation(s)
- Monica V Dragoman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Mary E Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Roos-Hesselink JW, Cornette J, Sliwa K, Pieper PG, Veldtman GR, Johnson MR. Contraception and cardiovascular disease. Eur Heart J 2015; 36:1728-34, 1734a-1734b. [DOI: 10.1093/eurheartj/ehv141] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
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9
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Merki-Feld GS, Skouby S, Serfaty D, Lech M, Bitzer J, Crosignani PG, Cagnacci A, Sitruk-Ware R. European Society of Contraception Statement on Contraception in Obese Women. EUR J CONTRACEP REPR 2014; 20:19-28. [DOI: 10.3109/13625187.2014.960561] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Munro MG. Acute uterine bleeding unrelated to pregnancy: a Southern California Permanente Medical Group practice guideline. Perm J 2014; 17:43-56. [PMID: 24355890 DOI: 10.7812/tpp/13-018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute uterine bleeding unrelated to pregnancy has been defined as bleeding "sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention." The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women.
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Affiliation(s)
- Malcolm G Munro
- Director of Gynecological Services for the Los Angeles Medical Center in California and a Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California Los Angeles. E-mail:
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Maxwell WD, Jacob M, Spiryda LB, Bennett CL. Selection of Contraceptive Therapy for Patients with Thrombophilia: A Review of the Evidence. J Womens Health (Larchmt) 2014; 23:318-26. [DOI: 10.1089/jwh.2013.4479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Whitney D. Maxwell
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Merna Jacob
- South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Lisa B. Spiryda
- Department of Obstetrics and Gynecology, University of Florida, College of Medicine, Gainesville, Florida
| | - Charles L. Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
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12
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Abstract
BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology Workshop Group. RESULTS VTE is a multifactorial disease with a baseline annual incidence around 50 per 100 000 at 25 years and 120 per 100 000 at age 50. Its major complication is pulmonary embolism, causing death in 1-2% of patients. Higher VTE risk is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together. In pregnancy, the risk of VTE is increased ~5-fold, while the use of combined hormonal contraception (CHC) doubles the risk and this relative risk is higher with the more recent pills containing desogestrel, gestodene and drospirenone when compared with those with levonorgestrel. Similarly, hormone replacement therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS Clinicians managing pregnancy or treating women for infertility or prescribing CHC and HRT should be aware of the increased risks of VTE and the need to take a careful medical history to identify additional co-existing risks, and should be able to diagnose VTE and know how to approach its prevention.
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Chakhtoura Z, Canonico M, Gompel A, Scarabin PY, Plu-Bureau G. Progestogen-only contraceptives and the risk of acute myocardial infarction: a meta-analysis. J Clin Endocrinol Metab 2011; 96:1169-74. [PMID: 21289250 DOI: 10.1210/jc.2010-2065] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The association between combined oral contraceptives (OC) and the risk of myocardial infarction (MI) has been intensively studied, and conclusions are controversial. While progestogen-only contraceptives (POC) are commonly used worldwide, their impact on cardiovascular diseases is poorly investigated and remains unclear. OBJECTIVE We carried out a meta-analysis based on EMBASE- and MEDLINE-referenced literature corresponding to OC marketed since 1960. METHODS Eligible articles published in English language describing OC or POC use and MI outcome were reviewed, and relevant ones were extracted. All types of POC and route of administration were considered. RESULTS Six case-control studies were identified. The combined odds ratio showed no increase in the MI risk with POC use (odds ratio = 1.07; 95% confidence interval, 0.62-1.84). This result was similar according to the route of administration, including implant, injectable, and oral POC. CONCLUSION Data from observational studies suggest no increase in risk of MI with POC use. However, these results are based on limited data. Further investigations are needed, especially among women at high MI risk.
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Affiliation(s)
- Zeina Chakhtoura
- Department of Gynecology and Endocrinology, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, 75004 Paris, France
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van Hylckama Vlieg A, Middeldorp S. Hormone therapies and venous thromboembolism: where are we now? J Thromb Haemost 2011; 9:257-66. [PMID: 21114755 DOI: 10.1111/j.1538-7836.2010.04148.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- A van Hylckama Vlieg
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, The Netherlands.
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van Hylckama Vlieg A, Helmerhorst FM, Rosendaal FR. The risk of deep venous thrombosis associated with injectable depot-medroxyprogesterone acetate contraceptives or a levonorgestrel intrauterine device. Arterioscler Thromb Vasc Biol 2010; 30:2297-300. [PMID: 20798377 DOI: 10.1161/atvbaha.110.211482] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the risk of venous thrombosis associated with nonoral contraceptives (ie, injectable depot-medroxyprogesterone acetate contraceptives, hormone [levonorgestrel]-releasing intrauterine devices, a contraceptive patch, or a contraceptive implant). METHODS AND RESULTS Analyses were performed in the Multiple Environmental and Genetic Assessment study, a large case-control study on risk factors for venous thrombosis. For the current analyses, we selected premenopausal women, aged 18 to 50 years, who were not pregnant nor within 4 weeks postpartum and were not using oral contraceptives; 446 patients and 1146 controls were included. Injectable depot-medroxyprogesterone acetate contraceptives were associated with a 3.6-fold (95% CI, 1.8- to 7.1-fold) increased risk of venous thrombosis compared with nonusers of hormonal contraceptives. The use of a levonorgestrel intrauterine device was not associated with an increased risk (odds ratio, 0.3; 95% CI, 0.1 to 1.1). Unfortunately, the few women using a contraceptive patch or an implant prevented a reliable estimate of the risk of thrombosis. CONCLUSIONS The risk of venous thrombosis was increased for injectable depot-medroxyprogesterone acetate contraceptive users, while we were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use. Therefore, the latter seems to be the safest option regarding the risk of venous thrombosis.
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Affiliation(s)
- Astrid van Hylckama Vlieg
- Department of Clinical Epidemiology, Leiden University Medical Center, C7-P, PO Box 9600, NL-2300 RC Leiden, the Netherlands
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Schuster J, Karlsson T, Karlström PO, Poromaa IS, Dahl N. Down-regulation of progesterone receptor membrane component 1 (PGRMC1) in peripheral nucleated blood cells associated with premature ovarian failure (POF) and polycystic ovary syndrome (PCOS). Reprod Biol Endocrinol 2010; 8:58. [PMID: 20537145 PMCID: PMC2902486 DOI: 10.1186/1477-7827-8-58] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 06/10/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Progesterone receptor membrane component 1 (PGRMC1) is a member of a progesterone-binding complex implicated in female reproduction. We aimed i) to determine the natural expression of PGRMC1 in peripheral nucleated blood cells throughout the menstrual cycle and ii) to investigate any association between PGRMC1 levels in leukocytes and conditions characterized by reduced fertility. METHODS We analyzed PGRMC1 expression in peripheral leukocytes from 15 healthy cycling women over four weeks. Additionally, we determined PGRMC1 levels in samples from patients with premature ovarian failure (POF) and polycystic ovary syndrome (PCOS) as well as in healthy postmenopausal women and male controls. The levels of PGRMC1 protein in nucleated peripheral blood cells were quantified by Western blot analysis. RESULTS PGRMC1 levels did not vary significantly throughout the menstrual cycle. We observed a significant down-regulation of PGRMC1 in postmenopausal women and in patients with premature ovarian failure (POF) and polycystic ovary syndrome (PCOS) when compared to early follicular phase of healthy women. CONCLUSION This study suggests that reduced levels of PGRMC1 in peripheral leukocytes are associated with perturbed ovulatory function.
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Affiliation(s)
- Jens Schuster
- Department of Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
| | - Teresia Karlsson
- Department of Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
| | - Per-Olof Karlström
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
- Department of Clinical Science, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | | | - Niklas Dahl
- Department of Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
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Grimes DA, Schulz KF, Raymond EG. Surrogate end points in women's health research: science, protoscience, and pseudoscience. Fertil Steril 2010; 93:1731-4. [DOI: 10.1016/j.fertnstert.2009.12.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 11/26/2022]
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Venous thrombosis and congenital absence of inferior vena cava in a patient with menorrhagia and pelvic pain. J Pediatr Adolesc Gynecol 2010; 23:e17-21. [PMID: 19643637 DOI: 10.1016/j.jpag.2009.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/16/2009] [Accepted: 04/27/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Agenesis of the inferior vena cava (IVC) is an uncommon congenital vascular malformation. We report a case in a teenage female recently started on oral contraception. CASE Because of menorrhagia, the patient had begun an oral contraceptive pill (OCP) 1(1/2) months prior to presentation. She initially presented with pelvic and lower back pain, and imaging showed a pelvic deep venous thrombosis (DVT) and an interrupted IVC. Anticoagulation was started, the OCP was discontinued, and a discussion occurred regarding the treatment options for her menorrhagia following her recent diagnosis. SUMMARY AND CONCLUSION The case presented shows the rare occurrence of the congenital absence of an IVC with pelvic thrombosis in a young female with a history of menorrhagia and new onset of pelvic pain. The evaluation of this case report leads to a comprehensive review in the treatment choice for menorrhagia with the preceding history of a thrombotic event.
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Chakhtoura Z, Canonico M, Gompel A, Thalabard JC, Scarabin PY, Plu-Bureau G. Progestogen-Only Contraceptives and the Risk of Stroke. Stroke 2009; 40:1059-62. [DOI: 10.1161/strokeaha.108.538405] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The association between combined oral contraceptives (OC) use and increased risk of stroke has been reported. While progestogen-only contraceptives (POC) are commonly used worldwide, their impact on cardiovascular disease remains unclear.
Methods—
A meta-analysis based on EMBASE and MEDLINE referenced literature corresponding to OCs marketed since 1960 was carried out. Eligible articles assessing the risk of stroke in relation to OC or POC were reviewed, and relevant studies were extracted. All types of POC and routes of administration were taken into account in the meta-analysis.
Results—
Six case-control studies were identified. The combined odd ratio (OR) showed no increase in the risk of stroke among POC users (OR=0.96; 95% confidence interval: 0.70 to 1.31). This result was similar according to the route of administration (either implant or injectable or oral POC).
Conclusion—
Data from observational studies show that POC use is not associated with an increased risk of stroke. However, these results are based on limited data. Further investigations are needed in women with risk factors of stroke.
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Affiliation(s)
- Zeina Chakhtoura
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
| | - Marianne Canonico
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
| | - Anne Gompel
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
| | - Jean-Christophe Thalabard
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
| | - Pierre-Yves Scarabin
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
| | - Geneviève Plu-Bureau
- From the Department of Gynecology and Endocrinology (Z.C., A.G., J.-C.T., G.P.-B.), Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, Paris; and INSERM Unit U780 (M.C., P.-Y.S., G.P.-B.), Paul Brousse Hospital, Villejuif, France
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Guay DR. Drug treatment of paraphilic and nonparaphilic sexual disorders. Clin Ther 2009; 31:1-31. [DOI: 10.1016/j.clinthera.2009.01.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Guay DR. Inappropriate sexual behaviors in cognitively impaired older individuals. ACTA ACUST UNITED AC 2008; 6:269-88. [DOI: 10.1016/j.amjopharm.2008.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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