1
|
Oliveira GMMD, Almeida MCCD, Arcelus CMA, Neto Espíndola L, Rivera MAM, Silva-Filho ALD, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCDO, Costa MENC, Castro MLD, Lemke VDMG, Lucena AJGD, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICDQ, Rivera IR, Kulak J, Moura LAZ, Pompei LDM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, Decoud MSPD, Paiva MSMDO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, Souza OFD, Medeiros OOD, Carvalho RCMD, Machado RB, Silva SCTFD, Rodrigues TDCV, Avila WS, Costa-Paiva LHSD, Wender MCO. Brazilian Guideline on Menopausal Cardiovascular Health - 2024. Arq Bras Cardiol 2024; 121:e20240478. [PMID: 39166619 PMCID: PMC11341215 DOI: 10.36660/abc.20240478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Affiliation(s)
| | | | | | - Larissa Neto Espíndola
- Hospital Santa Izabel, Salvador, BA - Brasil
- Hospital Municipal de Salvador, Salvador, BA - Brasil
| | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Carlos Japhet da Matta Albuquerque
- Hospital Santa Joana Recife, Recife PE - Brasil
- EMCOR - Diagnósticos do Coração LTDA, Recife PE - Brasil
- Hospital Barão de Lucena, Recife PE - Brasil
| | | | | | | | | | | | | | | | | | - Carisi Anne Polanczyk
- Hospital de Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre RS - Brasil
| | | | | | | | | | | | | | | | | | - Jaime Kulak
- Maceió AL - BrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Monica Acevedo
- Pontificia Universidad Católica de Chile, Santiago - Chile
| | - Monica Susana Ramirez
- Hospital Privado Rosario, Rosario - Argentina
- Instituto Universitario Rosario (IUNIR), Santa Fe - Argentina
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Mukherjee A, Roy S. Pulmonary Embolism With Pulmonary Infarction in a Patient Using the Annovera® Segesterone Acetate and Ethinylestradiol Combined Vaginal Contraceptive Ring. Cureus 2024; 16:e63129. [PMID: 39055459 PMCID: PMC11271816 DOI: 10.7759/cureus.63129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Combined hormonal contraceptives (CHC) are a very popular form of contraception among young women. Recently, vaginal contraceptive rings (VCR) have been formulated, offering greater convenience and ease of use. Venous thromboembolism (VTE) has been associated with CHC use and is a significant cause of mortality and morbidity in women. Here, we present the case of a 48-year-old woman who presented with right upper quadrant abdominal pain for four days associated with one day of shortness of breath. She had a history of anemia and abnormal uterine bleeding due to uterine fibroids. She was found to have a large embolus in the right pulmonary artery, associated with a right lower lobe pulmonary infarction. No evidence of lower-extremity deep venous thrombosis was found. She was using a segesterone acetate and ethinylestradiol combination VCR, which was removed. She was started on intravenous heparin anticoagulation with improvement in symptoms. This was later transitioned to an oral apixaban regimen prior to discharge. The exact mechanism of CHC-induced thrombotic risk remains unclear. They affect numerous proteins involved in the coagulation, anticoagulation, and thrombolytic pathways, thereby expressing their net thrombogenic potential. Estrogens have often been implicated as the more thrombogenic hormone, with progestogens being added to mitigate some of the risks. CHC use can cause a sixfold increased risk for VTE. Reducing the dose of estrogen and proper patient selection with attention to their risk profile remain essential for the safe use of these agents. This represents the first case report relating segesterone acetate and ethinylestradiol combination VCR to pulmonary embolism and infarction.
Collapse
Affiliation(s)
- Aveek Mukherjee
- Pulmonary Critical Care, University of Tennessee Health Science Center, Memphis, USA
| | - Sasmit Roy
- Nephrology, University of Virginia, Lynchburg, USA
- Nephrology, Liberty University Medical School, Lynchburg, USA
| |
Collapse
|
3
|
Horakova L, Kriemler S, Študent V, Pichler Hefti J, Hillebrandt D, Jean D, Mateikaitė-Pipirienė K, Paal P, Rosier A, Andjelkovic M, Beidlemann B, Derstine M, Keyes LE. Hormonal Contraception and Menstrual Cycle Control at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024. [PMID: 38607652 DOI: 10.1089/ham.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Horakova, Lenka , Susi Kriemler, Vladimír Študent, Jacqueline Pichler Hefti, David Hillebrandt, Dominique Jean, Kastė Mateikaitė-Pipirienė, Peter Paal, Alison Rosier, Marija Andjelkovic, Beth Beidlemann, Mia Derstine, and Linda E. Keyes. Hormonal contraception and menstrual cycle control at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 00:00-00, 2024. Background: Women who use hormonal contraception (HC) may have questions about their use during travel to high altitude. This scoping review summarizes current evidence on the efficacy and safety of HC and cycle control during high-altitude travel. Methods: We performed a scoping review for the International Climbing and Mountaineering Federation (UIAA) Medical Commission series on Women's Health in the Mountains. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including contraception) with additional publications found by hand search. Results: We identified 17 studies from 7,165 potentially eligible articles. No articles assessed the efficacy of contraception during a short-term high-altitude sojourn. Current data show no advantage or disadvantage in HC users for acclimatization or acute mountain sickness (AMS). Use of HC during high-altitude travel is common and safe for menses suppression. A potential concern of estrogen-containing HC is the increased thrombotic risk, which theoretically could be compounded in hypobaric hypoxia. Conclusions: Evidence is limited for the interaction of HC and high altitude on performance, thrombosis, and contraceptive efficacy. HC does not affect the risk of AMS. The most efficacious and safest method at high altitude is generally the one women are most familiar with and already using.
Collapse
Affiliation(s)
- Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University Prague, Kladno, Czech Republic
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vladimír Študent
- Department of Gynecology and Obstetrics, Prachatice Hospital, Prachatice, Czech Republic
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsorthy, United Kingdom
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth Beidlemann
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
4
|
Carrascosa JM, Echarri A, Gavín Sebastián O, García de la Peña P, Martínez Pérez O, Ramirez S, Valderrama M, Montoro Álvarez M. Contraceptive Recommendations for Women with Immune-Mediated Inflammatory Diseases: A Delphi Consensus. Adv Ther 2024; 41:1372-1384. [PMID: 38326688 DOI: 10.1007/s12325-023-02779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Immune-mediated inflammatory diseases (IMID) are a group of disorders characterized by chronic inflammation caused by an altered immune regulation in targeted organs or systems. IMID itself could have an implied increased risk of venous thromboembolism (VTE) and this risk varies throughout the course of the disease as well as with some contraceptive methods and treatments. The aim of this study was to present some key considerations in relation to contraception in women with IMID. METHODS This was an exploratory study conducted in Spain following the online modified Delphi methodology with two rounds of participation. Four questionnaires were designed for each medical specialty: gastroenterology, rheumatology, dermatology, and gynecology. Each questionnaire was divided in three domains: general recommendations about IMID, specific recommendations, and contraceptive methods for patients with IMID. A 5-point Likert scale measured agreement with each statement, with an 80% agreement threshold. Following the first round, the percentage of each response was calculated for every item. Subsequently, a second round was conducted to reach a consensus on the items for which discrepancies were observed. RESULTS A total of 52 and 50 experts participated in the first and second round, respectively. Participants agreed on the existence of a higher risk of VTE in inflammatory bowel diseases, psoriasis, and rheumatoid arthritis diseases. Regarding recommendations for contraceptive methods in patients with IMID, experts considered the hormonal intrauterine device (IUD) as a first-line contraceptive (80.0%) and low doses of progesterone-only pills if the latter is not recommended (88.0%). Most of the interviewees concurred on the importance of the patients' contraceptive needs during the disease course (98.1%). CONCLUSION Raising awareness and promoting a multidisciplinary relationship among the physicians involved in the therapeutic decisions by considering all the risk factors when prescribing a contraceptive method is important to prevent VTE in women with IMID.
Collapse
Affiliation(s)
- José Manuel Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | - Ana Echarri
- Servicio de Digestivo, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain
| | - Olga Gavín Sebastián
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | | | - Oscar Martínez Pérez
- Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Susan Ramirez
- Pfizer Medical SLU, Av. de Europa, 20, B, Alcobendas, 28108, Madrid, Spain
| | - Mónica Valderrama
- Pfizer Medical SLU, Av. de Europa, 20, B, Alcobendas, 28108, Madrid, Spain
| | | |
Collapse
|
5
|
Bauerfeind A, von Stockum S, Boehnke T, Heinemann K. Venous Thromboembolic Risk of Estradiol Valerate-Dienogest Compared with Ethinyl Estradiol-Levonorgestrel Combined Oral Contraceptives. Obstet Gynecol 2024; 143:431-434. [PMID: 38227942 DOI: 10.1097/aog.0000000000005509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
This pooled analysis compared the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) containing estradiol (E2) valerate-dienogest with those containing ethinyl E2-levonorgestrel. Data were retrieved from two large, prospective, observational cohort studies. Propensity score subclassification was applied to balance baseline parameters between the COC user cohorts. Crude and adjusted hazard ratios (HRs) were calculated based on the extended Cox model. The pooled data set included 11,616 E2 valerate-dienogest users and 18,681 ethinyl E2-levonorgestrel users, contributing 17,932 and 29,140 women-years of observation, respectively. A significantly decreased VTE risk in E2 valerate-dienogest COCs compared with ethinyl E2-levonorgestrel COCs was observed (propensity score-stratified HR 0.46, 95% CI, 0.22-0.98). This pooled analysis expands data from a previous postauthorization safety study and provides valuable real-world safety information on the relative safety of current COCs.
Collapse
Affiliation(s)
- Anja Bauerfeind
- Berlin Center for Epidemiology and Health Research (ZEG), Berlin, Germany
| | | | | | | |
Collapse
|
6
|
Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol 2024; 230:B17-B40. [PMID: 37866731 PMCID: PMC10961101 DOI: 10.1016/j.ajog.2023.10.031] [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] [Indexed: 10/24/2023]
Abstract
Pregnant individuals with sickle cell disease have an increased risk of maternal and perinatal morbidity and mortality. However, prepregnancy counseling and multidisciplinary care can lead to favorable maternal and neonatal outcomes. In this consult series, we summarize what is known about sickle cell disease and provide guidance for sickle cell disease management during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations.
Collapse
|
7
|
Barcellona D, Marongiu F, Grandone E. Contraceptives and Thrombosis: An Intertwined Revolutionary Road. Semin Thromb Hemost 2024; 50:91-95. [PMID: 36913971 DOI: 10.1055/s-0043-1764382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The development of oral contraceptives (OCs) began in 1921 and continued in the following years until the first regulatory approval from the Food and Drug Administration was granted in 1960. However, it took several years to realize that OCs presented an important but not frequent risk of venous thrombosis. Several reports ignored this dangerous effect and only in 1967 the Medical Research Council clearly stated this as an important risk. Later, research led to the formulation of second-generation OCs containing progestins, which nevertheless presented an increased thrombotic risk. In early 1980s, OCs containing third-generation progestins were introduced into the market. Only in 1995, it became clear that these new compounds induced a higher thrombotic risk than that related to the second-generation progestins. It appeared clear that the modulating action of progestins was against the procoagulant activity of estrogens. Lastly, at the end of the 2000s, OCs containing natural estrogens and a fourth-generation progestin (dienogest) became available. The prothrombotic effect of those natural products was not different from that of preparations containing second-generation progestins. Moreover, research over the years has produced much data on risk factors associated with OCs use such as age, obesity, cigarette smoking, and thrombophilia. These findings allowed us to better assess the individual thrombotic risk (both arterial and thrombotic) of each woman before offering an OC. Furthermore, research has shown that in high-risk people the use of single progestin is not dangerous as far as thrombosis is concerned. In conclusion, the OCs road has been long and difficult but has led to a great and unthinkable scientific and social enrichment since the 1960s.
Collapse
Affiliation(s)
- Doris Barcellona
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Departmental Unit of Thrombosis and Haemostasis, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Francesco Marongiu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Departmental Unit of Thrombosis and Haemostasis, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Elvira Grandone
- Thrombosis and Haemostasis Unit, I.R.C.C.S. 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, FG, Italy
- Department of Obstetrics, Gynaecology and Perinatal Medicine, First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| |
Collapse
|
8
|
Bindlish S. Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023. OBESITY PILLARS (ONLINE) 2023; 8:100092. [PMID: 38125656 PMCID: PMC10728709 DOI: 10.1016/j.obpill.2023.100092] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics in this CPS include obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Obesity increases the risk of thrombosis and cardiovascular disease via fat mass and adiposopathic mechanisms. Treatment of thrombosis or thrombotic risk includes healthful nutrition, physical activity, and the requisite knowledge of how body weight affects anti-thrombotic medications. In addition to obesity-related thrombotic considerations of acute coronary syndrome and ischemic non-hemorrhagic stroke, this Clinical Practice Statement briefly reviews the diagnosis and management of clinically relevant presentations of deep vein thromboses, pulmonary embolism, chronic venous stasis, varicose veins, superficial thrombophlebitis, lipodermatosclerosis, corona phlebectatica, chronic thromboembolic pulmonary hypertension, iliofemoral venous obstruction, pelvic venous disorder, post-thrombotic syndrome, as well as lymphedema and lipedema - which should be included in the differential diagnosis of other edematous or enlargement disorders of the lower extremities. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on obesity, thrombosis, and venous/lymphatic disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
Collapse
Affiliation(s)
- Shagun Bindlish
- Adjunct Faculty Touro University, 7554 Dublin Blvd, Dublin, CA, USA
| |
Collapse
|
9
|
Genazzani AR, Fidecicchi T, Arduini D, Giannini A, Simoncini T. Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice. Gynecol Endocrinol 2023; 39:2247093. [PMID: 37599373 DOI: 10.1080/09513590.2023.2247093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
The debate about contraception has become increasingly important as more and more people seek safe and effective contraception. More than 1 billion women of reproductive age worldwide need a method of family planning, and wellbeing, socio-economic status, culture, religion and more influence the reasons why a woman may ask for contraception. Different contraceptive methods exist, ranging from 'natural methods' (fertility awareness-based methods - FABMs) to barrier methods and hormonal contraceptives (HCs). Each method works on a different principle, with different effectiveness.FABMs and HCs are usually pitted against each other, although it's difficult to really compare them. FABMs are a valid alternative for women who cannot or do not want to use hormone therapy, although they may have a high failure rate if not used appropriately and require specific training. HCs are commonly used to address various clinical situations, although concerns about their possible side effects are still widespread. However, many data show that the appropriate use of HC has a low rate of adverse events, mainly related to personal predisposition.The aim of this review is to summarize the information on the efficacy and safety of FABMs and HCs to help clinicians and women choose the best contraceptive method for their needs.
Collapse
Affiliation(s)
- Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Fidecicchi
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Arduini
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
10
|
Grandone E, Antonucci E, Colaizzo D, De Laurenzo A, Cosmi B, Cini M, Legnani C, Testa S, Margaglione M, Palareti G. Venous Thromboembolism in Women of Childbearing Age: Insights from the START Registry. Thromb Haemost 2023; 123:1060-1068. [PMID: 37263294 DOI: 10.1055/s-0043-1769592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Women of childbearing age are exposed to venous thromboembolic risk mainly for pregnancy and use of oral contraceptives. The impact of risk factors (RF) on venous thromboembolism (VTE) in these circumstances is still unclear. AIM In the context of START registry, we aimed to investigate the weight of a series of RF on the occurrence of pregnancy- or combined oral contraceptive (COC)-associated VTE. MATERIALS AND METHODS We selected all women included in the START for VTE occurred between 18-42 years and compared those with a first or recurrent pregnancy/postpartum- (group A) or COC-VTE (group B) with those who had VTE outside these circumstances (group C). Final analysis included a cohort of 532 women. Follow-up data showed that there were no significant differences between the groups in terms of thrombotic and haemorrhagic complications. As for pregnancy-associated VTE, the overall outcome was good in terms of both maternal and fetal prognosis. RESULTS In a binary model of logistic regression, correcting for potential confounders, VTE family history conferred a significant and independent higher risk of COC-VTE compared with group C. Similarly, comparison between group A and C documented that family history significantly affected the risk of pregnancy-associated VTE. VTE in the group C was significantly associated with older age. Lastly, smoke was a significant risk factor for pregnancy/postpartum VTE when group A and group B were compared. CONCLUSION Present data suggest that in the setting of fertile women, family history of VTE has a greater role in predicting COC- and pregnancy/postpartum- VTE than outside these circumstances.
Collapse
Affiliation(s)
- Elvira Grandone
- Thrombosis and Haemostasis Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
- Ob/Gyn Department, University of Foggia, Foggia, Italy
- Ob/Gyn and Perinatal Medicine Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | | | - Donatella Colaizzo
- Thrombosis and Haemostasis Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Antonio De Laurenzo
- Thrombosis and Haemostasis Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Benilde Cosmi
- UO di Angiologia e Malattie della Coagulazione, Dipartimento Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna; Azienda Ospedaliero Universitaria S. Orsola-Malpighi, IRCCS, Bologna, Italy
| | - Michela Cini
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | | | - Sophie Testa
- Centro Emostasi e Trombosi, UUOO Laboratorio Analisi chimico-cliniche e microbiologiche, ASST Cremona, Cremona, Italy
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | |
Collapse
|
11
|
Foidart JM, Gemzell-Danielsson K, Kubba A, Douxfils J, Creinin MD, Gaspard U. The benefits of estetrol addition to drospirenone for contraception. AJOG GLOBAL REPORTS 2023; 3:100266. [PMID: 37854030 PMCID: PMC10580049 DOI: 10.1016/j.xagr.2023.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Ethinylestradiol and drospirenone combined oral contraceptive formulations have been marketed for >20 years. Drospirenone has antimineralocorticoid and anti-androgenic effects that may offer several health benefits. Recently, 2 new drospirenone-containing oral contraceptives entered the market, 1 as a progestin-only pill containing 4 mg drospirenone and the other as a combined oral contraceptive containing 15 mg estetrol and 3 mg drospirenone. Estetrol has a unique differential effect on nuclear and membrane estrogen α-receptors when compared with other estrogens, leading to low impact on the liver, breast, and hemostasis parameters and a beneficial effect on the endometrium, vagina, cardiovascular system, bone, and brain. Phase 3 clinical studies demonstrated that the Pearl Index (pregnancies per 100-woman-years) for drospirenone alone is 4.0 in the United States and 0.93 in the European Union and for the estetrol-drospirenone combination it is 2.65 and 0.44, respectively. Drospirenone alone demonstrates high rates of unscheduled bleeding and low rates of scheduled bleeding, whereas the estetrol-drospirenone combination demonstrates a predictable and regular bleeding profile for most users with a high stable rate of scheduled bleeding and a low rate of unscheduled bleeding, reported primarily as spotting only. The adverse event profiles and discontinuation rates owing to adverse events are comparable, and no clinically significant effects were observed on metabolic parameters with either product. Hemostatic assays for drospirenone do not fully evaluate all parameters although the testing that is available suggests negligible effects, whereas validated hemostatic assays demonstrate that the estetrol-drospirenone combination has limited impact on hemostasis. The introduction of 4 mg drospirenone and 15 mg estetrol with 3 mg drospirenone are valuable additions to the contraceptive market. Adding estetrol to 3 mg drospirenone provides advantages of contraceptive efficacy and a regular, predictable bleeding profile with minimal impact on hemostasis parameters.
Collapse
Affiliation(s)
- Jean Michel Foidart
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium (Prof Foidart and Prof Gaspard)
- Estetra SRL, an affiliate company of Mithra Pharmaceuticals, Liège, Belgium (Prof Foidart)
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden (Prof Gemzell-Danielsson)
| | - Ali Kubba
- Department of Gynecological Oncology, Guy's Hospital, London, United Kingdom (Prof Kubba)
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium (Prof Douxfils)
- Qualiblood s.a, Namur, Belgium (Prof Douxfils)
| | - Mitchell D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA (Prof Creinin)
| | - Ulysse Gaspard
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium (Prof Foidart and Prof Gaspard)
| |
Collapse
|
12
|
Lempesis IG, Apple SJ, Duarte G, Palaiodimos L, Kalaitzopoulos DR, Dalamaga M, Kokkinidis DG. Cardiometabolic effects of SGLT2 inhibitors on polycystic ovary syndrome. Diabetes Metab Res Rev 2023; 39:e3682. [PMID: 37392147 DOI: 10.1002/dmrr.3682] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/03/2023] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting many women of reproductive age. Although its physiology is poorly understood, hyperandrogenemia and insulin resistance play a pivotal role in this complex syndrome, predisposing patients to a variety of cardiovascular and metabolic modalities. Current therapeutic options, including lifestyle modifications and medications, often do not satisfactorily improve clinical outcomes. SGLT2 inhibitors (SGLT-2i) are a novel option which can potentially improve many hormonal and metabolic parameters for patients with PCOS, though the net cardiovascular effects remain under investigation in this population of patients with PCOS. Overall, the use of SGLT-2i may be associated with beneficial somatometric, metabolic and hormonal outcomes of PCOS. To date, all available studies have recorded body mass index, waist and hip circumference, and fat mass reductions, improved insulin and androgen levels, and reduced blood pressure. The aim of the present review is to summarise PCOS-related manifestations and mechanisms leading to cardiovascular disease, to explore the cardiometabolic impact of SGLT2i on PCOS, and to critically analyse the cardiometabolic and hormonal outcomes of the recent studies on the use of SGLT2i in women with PCOS.
Collapse
Affiliation(s)
- Ioannis G Lempesis
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel J Apple
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gustavo Duarte
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Leonidas Palaiodimos
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Maria Dalamaga
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Opoku AA, Onifade RA, Odukoya OA. Challenges of morbid obesity in gynecological practice. Best Pract Res Clin Obstet Gynaecol 2023; 90:102379. [PMID: 37473647 DOI: 10.1016/j.bpobgyn.2023.102379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
Obesity is currently a global pandemic, with increasing trends worldwide. Data from the WHO, US CDC, and the UK show an increasing trend, with 50% and 25% of the US population expected to be obese and morbidly obese by 2030. Obesity affects several aspects of health, with increased risks of cardiovascular disease, diabetes, metabolic syndrome, and several malignancies. Morbid obesity significantly impacts several aspects of female life and health, from adolescence, through the reproductive years, to the postmenopausal age group. In gynecology, there is a higher prevalence of menstrual disorders and infertility and reduced success rates of assisted reproduction; increased risk of miscarriage; pelvic organ prolapse; and endometrial, ovarian, and breast cancers. Surgery in the patient with morbid obesity is associated with several logistical challenges as well as increased surgical and peri-operative risks and increased cost. In this review, we provide an overview of the current literature, with a focus on challenges of morbid obesity in gynecological practice.
Collapse
Affiliation(s)
- Albert A Opoku
- Al Wakra Hospital, Hamad Medical Corporation, P. O. Box 82228, Al Wakra, Qatar; Weill Cornell Medical College, P. O. Box 24144, Doha, Qatar.
| | - Richard Adedamola Onifade
- Al Wakra Hospital, Hamad Medical Corporation, P. O. Box 82228, Al Wakra, Qatar; Weill Cornell Medical College, P. O. Box 24144, Doha, Qatar.
| | - Olusegun A Odukoya
- Al Wakra Hospital, Hamad Medical Corporation, P. O. Box 82228, Al Wakra, Qatar.
| |
Collapse
|
14
|
Baldwin MK, Samuelson Bannow B, Rosovsky RP, Sokkary N, Srivaths LV. Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias. Res Pract Thromb Haemost 2023; 7:100161. [PMID: 37274174 PMCID: PMC10238261 DOI: 10.1016/j.rpth.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/08/2023] [Indexed: 06/06/2023] Open
Abstract
There is widespread use of gonadal steroid hormone therapy for a variety of indications throughout the reproductive and postreproductive lifespan. These therapies may have particular benefits and specific risk among those with blood disorders, including inherited or acquired bleeding disorders, thrombophilia, thrombosis, or anemia. This clinical review is intended to provide a guidance for counseling and management of adolescent and adult biologic females with thrombophilic risk factors and/or thrombosis who require hormonal therapy. In general, synthetic estrogens present in contraceptive products should be avoided in those with a personal or strong family history of thrombosis or thrombophilias. In contrast, natural estrogens present in formulations for climacteric symptom management do not need to be avoided, and vaginal or transdermal formulations are preferred. Likewise, transdermal estradiol is preferred for gender-affirming hormone therapy and requires individualized assessment in those at high risk of thrombosis. Progestogens (either synthetic progestins or naturally occurring progesterone) can be used safely in nearly all patients. There is minimal safety evidence among anticoagulated patients at risk for thrombosis, which requires a patient-specific approach when discussing hormone therapies.
Collapse
Affiliation(s)
- Maureen K. Baldwin
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel P. Rosovsky
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Medicine, Division of Hematology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sokkary
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Children’s Healthcare of Atlanta/Emory School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia, USA
| | - Lakshmi V. Srivaths
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| |
Collapse
|
15
|
Zuurbier SM, Santos AN, Flemming KD, Schmidt B, Jabbarli R, Lanzino G, Sure U, Dammann P. Female Hormone Therapy and Risk of Intracranial Hemorrhage From Cerebral Cavernous Malformations: A Multicenter Observational Cohort Study. Neurology 2023; 100:e1673-e1679. [PMID: 36754635 PMCID: PMC10115495 DOI: 10.1212/wnl.0000000000206888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Female hormone therapy (oral contraception in female patients of reproductive age and menopausal hormone therapy in postmenopausal patients) is not withheld from patients with cerebral cavernous malformations (CCMs), although the effects of these drugs on the risk of intracranial hemorrhage are unknown. We investigated the association between female hormone therapy and intracranial hemorrhage in female patients with CCM in 2 large prospective, multicenter, observational cohort studies. METHODS We included consecutive patients with a CCM. We compared the association between use of female hormone therapy and the occurrence of intracranial hemorrhage due to the CCM during up to 5 years of prospective follow-up in multivariable Cox proportional hazards regression. We performed an additional systematic review through Ovid MEDLINE and Embase from inception to November 2, 2021, to identify comparative studies and assess their intracranial hemorrhage incidence rate ratio according to female hormone therapy use. RESULTS Of 722 female patients, aged 10 years or older at time of CCM diagnosis, 137 used female hormone therapy at any point during follow-up. Female hormone therapy use (adjusted for age, mode of presentation, and CCM location) was associated with an increased risk of subsequent intracranial hemorrhage (46/137 [33.6%] vs 91/585 [15.6%] and adjusted hazard ratio 1.56, 95% CI 1.09-2.24; p = 0.015). Use of oral contraceptives in female patients aged 10-44 years adjusted for the same factors was associated with a higher risk of subsequent intracranial hemorrhage (adjusted hazard ratio 2.00, 95% CI 1.26-3.17; p = 0.003). Our systematic literature search showed no studies reporting on the effect of female hormone therapy on the risk of intracranial hemorrhage during follow-up. DISCUSSION Female hormone therapy use is associated with a higher risk of intracranial hemorrhage from CCMs. These findings raise questions about the safety of female hormone therapy in clinical practice in patients with CCM. Further studies evaluating clinical factors raising risk of thrombosis may be useful to determine which patients may be most susceptible to intracranial hemorrhage. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that female hormone therapy use is associated with a higher risk of intracranial hemorrhage in patients with CCM.
Collapse
Affiliation(s)
- Susanna M Zuurbier
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN.
| | - Alejandro N Santos
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Kelly D Flemming
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Börge Schmidt
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Ramazan Jabbarli
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Giuseppe Lanzino
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Ulrich Sure
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| | - Philipp Dammann
- From the Amsterdam UMC (S.M.Z.), The Netherlands; University Hospital of Essen (A.N.S., B.S., R.J., U.S., P.D.), Essen; Center for Translational Neuroscience and Behavioral Science (C-TNBS) (A.N.S., R.J., U.S., P.D.), University of Duisburg-Essen, Germany; and Mayo Clinic (K.D.F., G.L.), Rochester, MN
| |
Collapse
|
16
|
Otto AK, Klein DA, Lau M, Santelli J, Dhar CP, Vyver E, Hwang LY. It's Time for Over-the-Counter Oral Contraceptive Pills. J Adolesc Health 2023; 72:829-830. [PMID: 37032214 DOI: 10.1016/j.jadohealth.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Alana K Otto
- Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
| | - David A Klein
- Departments of Family Medicine and Pediatrics, Uniformed Services University, Bethesda, Maryland; Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California
| | - May Lau
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Santelli
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Cherie P Dhar
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ellie Vyver
- Department of Pediatrics, Section of Adolescent Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Loris Y Hwang
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
17
|
CHERNUKHA L, VLASENKO O, RODIONOVA I, MARKOVETS I, VLASENKO D, VAHIS Y. Uterine leiomyomas and problems of deep vein thrombosis of the lower limbs. View of a vascular specialist. ACTA PHLEBOLOGICA 2022. [DOI: 10.23736/s1593-232x.22.00533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
18
|
Zhang Y, Zhu Y, Sun J. Analysis of Adverse Events and Medical Errors in Long-Term Hormone Treatments for Endometriosis: A Study Based on the US Food and Drug Administration Event Reporting System. Int J Womens Health 2022; 14:1237-1250. [PMID: 36097448 PMCID: PMC9464009 DOI: 10.2147/ijwh.s377418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To investigate adverse events and medical errors, as well as their possible risk factors, of combined oral contraceptives and progestins used in patients with endometriosis. Patients and Methods Reports between January 1, 2014 and September 30, 2021 about patients with endometriosis in US Food and Drug Administration Adverse Event Reporting System were analyzed. Disproportional analysis was performed with the Gamma-Poisson Shrinker model to detect overreported drug-event pairs. Logistic regression analysis was utilized to explore potential risk factors. Results There were 823 reports on long-term hormone treatments and 6247 reports on other drugs after removing duplicates, most of which were reported by consumers and were from the United States. Procedural complications and product issues were common among long-term hormone treatment users, while some other new adverse events emerged in subgroup analysis of different dosage forms of progestin. Polytherapy was negatively associated with off label use (adjusted OR = 0.47, 95% CI 0.22-0.94) and product use in unapproved indication (adjusted OR = 0.36, 95% CI 0.15-0.76) for combined oral contraceptive users. Combined oral contraceptive users aged greater than or equal to 30 were less likely to have product use issue (adjusted OR = 0.33, 95% CI 0.12-0.82) but were at higher risk of pulmonary embolism (adjusted OR = 4.04, 95% CI 1.35-17.43). Conclusion Long-term hormone treatment products in this study are generally safe for endometriosis, while newly detected signals need to be validated by further exploration. Patients' tolerance and fertility desire should be considered when preparing treatment plans.
Collapse
Affiliation(s)
- Yuxin Zhang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Yiping Zhu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Jing Sun
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| |
Collapse
|
19
|
Barnett C, Bauerfeind A, Von Stockum S, Heinemann K. Thromboembolic safety of norethisterone vs levonorgestrel in combined oral contraceptive users: a pooled analysis of 4 large prospective cohort studies. AJOG GLOBAL REPORTS 2022; 2:100041. [PMID: 36274960 PMCID: PMC9563933 DOI: 10.1016/j.xagr.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Norethisterone (acetate) and levonorgestrel are marketed globally as components of combined oral contraceptives. Although guidelines recommend both as first-line combined oral contraceptives, no direct, comparative safety studies are available. OBJECTIVE We directly compared the thromboembolic event risk associated with the use of norethisterone acetate-containing and levonorgestrel-containing combined oral contraceptives. STUDY DESIGN Data regarding the cohorts of interest, norethisterone/norethisterone acetate (ethinylestradiol ≤30 µg) and levonorgestrel (ethinylestradiol ≤30 µg), were retrieved from a pooled dataset comprising 4 prospective, noninterventional, active-surveillance cohort studies in 14 European countries, the United States, and Canada, with similar study design but differing medication cohorts. Baseline characteristics and parameters of reproductive, contraceptive, and medical history were summarized using descriptive statistics. Propensity score subclassification was applied to balance baseline parameters between cohorts. Time-to-event analysis of venous thromboembolic events was performed on the basis of the extended Cox model to calculate crude and adjusted hazard ratios, including 95% confidence intervals. The time of venous thromboembolic events was censored at the end of the observation period for women who did not have an event. Women who dropped out or were lost to follow-up without reported venous thromboembolic events were censored at the time they last confirmed that they did not have an event. RESULTS The pooled dataset included 235,437 combined oral contraceptive users who were followed up for a total of 571,163 women years. Among these, 40,142 women were users of norethisterone/norethisterone acetate (ethinylestradiol ≤30 µg), and 39,098 women were users of levonorgestrel (ethinylestradiol ≤30 µg), contributing 61,976 and 84,816 women years of observation, respectively. The observed prevalence of prognostic factors at baseline showed typical features of US and European combined oral contraceptive users. Both cohorts showed a similar, low rate of thromboembolic events, and we could exclude a 1.5-fold increased venous thromboembolism risk for norethisterone/norethisterone acetate relative to levonorgestrel (adjusted hazard ratio, 0.73; 95% confidence interval, 0.48–1.11). CONCLUSION These data confirm the similar risk profiles of norethisterone/norethisterone acetate and levonorgestrel regarding thromboembolic events in routine combined oral contraceptive use of around 80,000 women from Europe and the United States/Canada. The analysis provides reassurance for both combined oral contraceptive users and clinicians regarding the safety of oral contraceptives and potentially opens discussion on norethisterone acetate as a potential gold standard therapy in clinical and postmarket research alongside levonorgestrel-combined oral contraceptives.
Collapse
Affiliation(s)
- Clare Barnett
- Corresponding author: Clare Barnett, MBBS (Hons), MPH.
| | | | | | | |
Collapse
|
20
|
Bio-Inspired Proanthocyanidins from Blueberries’ Surface Coating Prevents Red Blood Cell Agglutination on Urinary Silicon-Based Catheters. COATINGS 2022. [DOI: 10.3390/coatings12020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Thrombosis can cause the occlusion of implantable medical devices, leading to the rejection of the device and subsequent mortality. Thrombosis is primarily induced by red blood aggregation and coagulation. The administration of anticoagulant drugs is generally used as a treatment to avoid these processes. Adverse effects such as bleeding in the event of an anticoagulant overdose, osteoporosis associated with prolonged use, hypersensitivity, and hives have been reported. New strategies such as biomolecule surface functionalization have recently been studied to overcome these problems. In this study, we report a novel coating composed of polydopamine (PDA) and proanthocyanidins (PACs) from blueberry extract to avoid red blood aggregation in short-term use medical devices such as silicone catheters. We showed that PDA formed stable films on silicone surfaces and PACs could be immobilized on PDA layers using laccase as a catalyst. The PDA–PACs films decreased surface hydrophilicity, increased surface roughness, and decreased plasma protein adsorption. The films were stable in phosphate buffer saline (PBS) and cell culture media. Furthermore, red blood cell adsorption and aggregation decreased. These effects are attributed to changes in the membrane fluidity that influences adhesion, the steric hindrance of the layers, and the low adsorption of plasma proteins on the PAC layer.
Collapse
|
21
|
Greco S, Pellegrino P, Zannotti A, Delli Carpini G, Ciavattini A, Reis FM, Ciarmela P. Phytoprogestins: Unexplored Food Compounds with Potential Preventive and Therapeutic Effects in Female Diseases. Nutrients 2021; 13:nu13124326. [PMID: 34959877 PMCID: PMC8705436 DOI: 10.3390/nu13124326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
In recent years, there has been an increasing interest in natural therapies to prevent or treat female diseases. In particular, many studies have focused on searching natural compounds with less side effects than standard hormonal therapies. While phytoestrogen-based therapies have been extensively studied, treatments with phytoprogestins reported in the literature are very rare. In this review, we focused on compounds of natural origin, which have progestin effects and that could be good candidates for preventing and treating female diseases. We identified the following phytoprogestins: kaempferol, apigenin, luteolin, and naringenin. In vitro studies showed promising results such as the antitumoral effects of kaempferol, apigenin and luteolin, and the anti-fibrotic effects of naringenin. Although limited data are available, it seems that phytoprogestins could be a promising tool for preventing and treating hormone-dependent diseases.
Collapse
Affiliation(s)
- Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.G.); (P.P.); (A.Z.)
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.G.); (P.P.); (A.Z.)
| | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.G.); (P.P.); (A.Z.)
- Department of Specialist and Odontostomatological Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (G.D.C.); (A.C.)
| | - Giovanni Delli Carpini
- Department of Specialist and Odontostomatological Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (G.D.C.); (A.C.)
| | - Andrea Ciavattini
- Department of Specialist and Odontostomatological Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (G.D.C.); (A.C.)
| | - Fernando M. Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil;
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.G.); (P.P.); (A.Z.)
- Correspondence: ; Tel.: +39-0712206270
| |
Collapse
|
22
|
Lahoti A, Yu C, Brar PC, Dalgo A, Gourgari E, Harris R, Kamboj MK, Marks S, Nandagopal R, Page L, Raman V, Reynolds DG, Sarafoglou K, Terrell C, Stanley TL. An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health. J Pediatr Endocrinol Metab 2021; 34:1355-1369. [PMID: 34388330 DOI: 10.1515/jpem-2020-0539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Suppression of menstruation and/or ovarian function in adolescent girls may be desired for a variety of reasons. Numerous medical options exist. The choice of the appropriate modality for an individual patient depends on several factors based on differences in the efficacy of achieving menstrual suppression as well as in their side effect profiles. Adolescence is also a period of bone mass accrual in girls, and several of these modalities may negatively influence peak bone mass. This review focuses on the efficacy of achieving menstrual suppression and the effect on bone health of the various options through an overview of the current literature and also highlights areas in need of further research.
Collapse
Affiliation(s)
- Amit Lahoti
- Pediatric Endocrine Division, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christine Yu
- Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Preneet Cheema Brar
- Division of Pediatric Endocrinology and Diabetes, NYU Grossman School of Medicine, New York, NY, USA
| | - Austin Dalgo
- Center for Bioethics and Health Equity, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evgenia Gourgari
- Pediatric Endocrinology Division, Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Rebecca Harris
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital at The Ohio State University, Columbus, OH, USA
| | - Seth Marks
- Section of Pediatric Endocrinology and Metabolism, Department of Pediatrics and Child Health, Children's Hospital HSC Winnipeg, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Radha Nandagopal
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Laura Page
- Division of Endocrinology, Department of Pediatrics, Duke University, Durham, NC, USA
| | | | - Danielle G Reynolds
- Diabetes and Endocrinology Center, University of South Florida, Tampa, FL, USA
| | - Kyriakie Sarafoglou
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Carrie Terrell
- Division of General Obstetrics, Gynecology, Midwifery and Family Planning at the University of Minnesota Medical School, Minneapolis, MN, USA
| | - Takara L Stanley
- Pediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Management of Maternal Complex Congenital Heart Disease During Pregnancy. Curr Heart Fail Rep 2021; 18:353-361. [PMID: 34783997 DOI: 10.1007/s11897-021-00534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to discuss the risk stratification and management of pregnancy in women with complex congenital heart disease. RECENT FINDINGS Classifying congenital heart defects (CHD) including both anatomy and physiology is important for maternal risk stratification. Although most women with CHD can tolerate the physiological challenge of pregnancy, some may experience serious risks both to their health and that of their foetus. The WHO maternal risk classification model remains the best-validated risk measure. Ideally, women with CHD should have pre-conception assessment with a CHD cardiologist. General principles of management, such as need for expert centre delivery, a multidisciplinary team, epidural and mode of delivery are based on WHO risk in combination with expert assessment of status. CHD is increasingly prevalent in women of child-bearing age. Assessment by an adult CHD cardiologist, ideally pre-conception, is key in assessing and minimising risk to mother and foetus.
Collapse
|
24
|
Yanes Cardozo LL, Romero DG. Management of cardiometabolic complications in polycystic ovary syndrome: Unmet needs. FASEB J 2021; 35:e21945. [PMID: 34606638 PMCID: PMC10146586 DOI: 10.1096/fj.202002526rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and the most common cause of androgen excess in reproductive-age women. The heterogeneity of the clinical presentation in PCOS patients suggests the involvement of multiples abnormal physiological pathways. In addition, women with PCOS have a high prevalence of cardiometabolic risk factors. Unfortunately, limited effective evidence-based therapeutic agents are available to treat the cardiometabolic complications in PCOS patients. Insights from recent studies highlight the multiple opportunities to deliver timely effective medical care for women with PCOS. This perspective manuscript aims to highlight the unmet need for effective and safe management of the cardiometabolic complications in PCOS patients.
Collapse
Affiliation(s)
- Licy L Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Damian G Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
25
|
Costeira R, Lee KA, Murray B, Christiansen C, Castillo-Fernandez J, Ni Lochlainn M, Capdevila Pujol J, Macfarlane H, Kenny LC, Buchan I, Wolf J, Rymer J, Ourselin S, Steves CJ, Spector TD, Newson LR, Bell JT. Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study. PLoS One 2021; 16:e0257051. [PMID: 34506535 PMCID: PMC8432854 DOI: 10.1371/journal.pone.0257051] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
It has been widely observed that adult men of all ages are at higher risk of developing serious complications from COVID-19 when compared with women. This study aimed to investigate the association of COVID-19 positivity and severity with estrogen exposure in women, in a population based matched cohort study of female users of the COVID Symptom Study application in the UK. Analyses included 152,637 women for menopausal status, 295,689 women for exogenous estrogen intake in the form of the combined oral contraceptive pill (COCP), and 151,193 menopausal women for hormone replacement therapy (HRT). Data were collected using the COVID Symptom Study in May-June 2020. Analyses investigated associations between predicted or tested COVID-19 status and menopausal status, COCP use, and HRT use, adjusting for age, smoking and BMI, with follow-up age sensitivity analysis, and validation in a subset of participants from the TwinsUK cohort. Menopausal women had higher rates of predicted COVID-19 (P = 0.003). COCP-users had lower rates of predicted COVID-19 (P = 8.03E-05), with reduction in hospital attendance (P = 0.023). Menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P = 2.22E-05) for HRT users alone. The findings support a protective effect of estrogen exposure on COVID-19, based on positive association between predicted COVID-19 with menopausal status, and negative association with COCP use. HRT use was positively associated with COVID-19, but the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential unaccounted for confounders and comorbidities.
Collapse
Affiliation(s)
- Ricardo Costeira
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Karla A. Lee
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Colette Christiansen
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Juan Castillo-Fernandez
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | | | | | - Louise C. Kenny
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | | | - Janice Rymer
- Department of Women’s Health, King’s College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Timothy D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Louise R. Newson
- Newson Health Menopause & Wellbeing Centre, Stratford-Upon-Avon, United Kingdom
| | - Jordana T. Bell
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| |
Collapse
|
26
|
de Vries L, Baum M, Horovitz M, Phillip M, Barash G, Pinhas-Hamiel O, Lazar L. Management of Fully Pubertal Girls With Nonclassical Congenital Adrenal Hyperplasia: Glucocorticoids Versus Oral Contraceptives. Endocr Pract 2021; 28:44-51. [PMID: 34438053 DOI: 10.1016/j.eprac.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare clinical outcomes of 3 treatment regimens-glucocorticoids (GCs), oral contraceptives (OCs), or a combination of both-administered to adolescents and young women diagnosed in childhood with nonclassical congenital adrenal hyperplasia (NCCAH), who had been treated with GCs until their adult height was achieved. METHODS A retrospective study of medical records of 53 female patients with NCCAH followed in 3 tertiary pediatric endocrinology institutes. The 3 treatment groups were compared for the prevalence of hirsutism and acne, standardized body mass index (BMI)-standard deviation score (SDS), and androgen levels at the attainment of adult height (baseline), 1-year later, and at the last documented visit. RESULTS At baseline, there were no significant differences among groups in BMI-SDS, androgen levels, hirsutism prevalence, acne, or irregular menses. From baseline to the last visit, the rate of hirsutism declined significantly only in the OC group (37.5% vs 6.2%, respectively; P = .03). The rate of acne declined in the combined group (50% vs 9%, respectively; P = .03) with a similar tendency in the OC group (50% vs 12.5%, respectively; P = .05). No significant changes were observed in BMI-SDS for the entire cohort or any subgroup during follow-up. A significant rise in androstenedione (P < .001), testosterone (P < .01), and 17-hydroxyprogesterone (P < .01) levels was observed only in the OC group. CONCLUSION In girls diagnosed in childhood with NCCAH, who require treatment for hyperandrogenism following completion of linear growth, management should be tailored individually using a patient-centered approach. Treatment with OCs might be better than that with GCs for regression of hirsutism and acne. The long-term effects of elevated levels of androgens associated with this treatment regimen should be further studied.
Collapse
Affiliation(s)
- Liat de Vries
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Baum
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Horovitz
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Barash
- Pediatric Endocrinology and Diabetes Institute, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Liora Lazar
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
27
|
Barnett C, Bauerfeind A, von Stockum S, Heinemann K. Thromboembolic safety profile of low-dose estradiol (valerate) in combined hormonal preparations: Implications for the development of new hormonal endometriosis and uterine fibroid therapies. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211019546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Several promising new medications containing low-dose estradiol (E2) in combination with a progestin and an additional component, such as gonadotropin-releasing hormone antagonists, are currently being developed for use in pre-menopausal women. Objective: This pooled analysis was designed to estimate the thromboembolic safety profile of E2 and its ester, estradiol valerate (E2Val), when used in combined hormonal treatments in a pre-menopausal population. Methods: Data regarding users of combined oral contraceptives (COCs) and combined menopausal hormonal therapy (MHT) containing either E2/E2Val or ethinylestradiol (EE) ⩽ 30 µg were retrieved from five large prospective, non-interventional, cohort studies in Europe, US, and Canada with similar study design but differing medication cohorts. Propensity score sub-classification was applied to balance baseline parameters between cohorts and time-to-event analysis of venous thromboembolic events (VTE) was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios (HR). Results: (1) Crude incidence rates of VTE were higher in MHT users compared to pre-menopausal COC users, (2) the VTE risk in menopausal users of E2/E2Val-norethindrone acetate was not higher than that in menopausal users of E2/E2Val-progestin (adjusted HR 0.71; 95% confidence interval, 0.41-1.26) and (3) the VTE risk in pre-menopausal users of E2/E2Val-progestin was similar, or lower, than pre-menopausal users of EE⩽30µg-progestin (adjusted HR 0.49; 95% confidence interval, 0.28–0.84). Conclusion: Our data presents a solid safety assessment of combined hormonal preparations containing E2/E2Val. We conclude that the risk of E2/E2Val-norethindrone acetate in pre-menopausal users is unlikely to be higher than the known risk of COCs containing EE ⩽ 30 µg-progestin.
Collapse
Affiliation(s)
- Clare Barnett
- ZEG - Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | - Anja Bauerfeind
- ZEG - Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | - Sophia von Stockum
- ZEG - Berlin Center for Epidemiology and Health Research, Berlin, Germany
| | - Klaas Heinemann
- ZEG - Berlin Center for Epidemiology and Health Research, Berlin, Germany
| |
Collapse
|
28
|
Lindley KJ, Bairey Merz CN, Davis MB, Madden T, Park K, Bello NA. Contraception and Reproductive Planning for Women With Cardiovascular Disease: JACC Focus Seminar 5/5. J Am Coll Cardiol 2021; 77:1823-1834. [PMID: 33832608 PMCID: PMC8041063 DOI: 10.1016/j.jacc.2021.02.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/30/2022]
Abstract
The majority of reproductive-age women with cardiovascular disease are sexually active. Early and accurate counseling by the cardiovascular team regarding disease-specific contraceptive safety and effectiveness is imperative to preventing unplanned pregnancies in this high-risk group of patients. This document, the final of a 5-part series, provides evidence-based recommendations regarding contraceptive options for women with, or at high risk for, cardiovascular disease as well as recommendations regarding pregnancy termination for women at excessive cardiovascular mortality risk due to pregnancy.
Collapse
Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ki Park
- Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
29
|
Oguz SH, Yildiz BO. An Update on Contraception in Polycystic Ovary Syndrome. Endocrinol Metab (Seoul) 2021; 36:296-311. [PMID: 33853290 PMCID: PMC8090477 DOI: 10.3803/enm.2021.958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.
Collapse
Affiliation(s)
- Seda Hanife Oguz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Hormonal therapy is administered for multiple indications including contraception, alleviation of menopausal symptoms, hypogonadism, and more recently, gender-affirming care. Data suggest varying degrees of increased risk for venous thromboembolism (VTE). RECENT FINDINGS While oral progestin only methods do not appear to increase the risk of VTE, an association was seen with injection progestin contraception. Combined oral contraception with low-dose ethinyl estradiol and most types of progestin increased the risk of VTE compared with levonorgestrel-containing oral therapies. While transdermal hormonal contraception has been previously associated with increased VTE, a recently approved levonorgestrel and ethinyl estradiol transdermal patch reported low rates (<0.2%) in a large single-arm open-label study. Women receiving postmenopausal HRT experienced an increased risk of VTE in a dose-dependent manner when using oral hormonal therapy while nonoral methods, such as topical estrogen, did not appear to increase the risk of VTE. Some studies suggest no increased risk of VTE with testosterone therapy, however, a recent case-crossover study suggested higher VTE risk in men on testosterone, particularly men less than age 65 without hypogonadism. Route of administration had no effect on VTE rates. The estimated incidence rate of VTE risk in transgender women receiving estrogen therapy is 2.3 per 1000 person years, but may be imprecise due to heterogeneity in studies included in published meta-analyses. Surgical risk estimates are primarily indirect data drawn from cisgender patients receiving hormone therapy in the perioperative setting. SUMMARY Hormonal therapy affects VTE risk to varying degrees dependent on specific type of hormone, formulation, and occasionally route of delivery.
Collapse
|
31
|
Duijkers I, Klipping C, Kinet V, Jost M, Bastidas A, Foidart JM. Effects of an oral contraceptive containing estetrol and drospirenone on ovarian function. Contraception 2021; 103:386-393. [PMID: 33689786 DOI: 10.1016/j.contraception.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of estetrol 15 mg/drospirenone 3 mg on ovarian function. STUDY DESIGN Single-center, randomized, open-label, parallel study in healthy young women with proven ovulatory cycles. Participants received either estetrol 15 mg/drospirenone 3 mg (E4/DRSP) (n = 41) or ethinylestradiol 20 µg/drospirenone 3 mg (EE/DRSP) (n = 41) in a 24/4-day regimen for 3 consecutive cycles. Follicular size and endometrial thickness were measured by transvaginal ultrasound every 3 days in cycles 1 and 3. Blood was sampled for hormone analysis. Ovarian function expressed as Hoogland score was based on follicular size, serum estradiol (E2) and progesterone (P) concentrations. Ovulation was defined as a ruptured follicle-like structure >13 mm with serum E2 concentrations >100 pmol/L and serum P concentrations >5 nmol/L. We assessed return of ovulation after treatment cessation, and safety throughout the study. RESULTS None of the participants ovulated with E4/DRSP use, while one participant ovulated once and one participant ovulated twice during EE/DRSP treatment. Most participants had a Hoogland score of 1 (no ovarian activity) in cycle 1 (85.0% and 82.9% of participants on E4/DRSP and EE/DRSP, respectively) and in cycle 3 (65.8% and 83.8%, respectively). E4/DRSP suppressed follicle-stimulating hormone and luteinizing hormone to a lesser extent than EE/DRSP, whereas both treatments comparably suppressed E2 and P and endometrial thickness. Return of ovulation occurred, on average, 15.5 days after E4/DRSP treatment discontinuation. E4/DRSP was safe and well-tolerated. CONCLUSIONS E4 15 mg/DRSP 3 mg results in adequate ovulation inhibition and ovarian function suppression, comparable to a marketed combined oral contraceptive containing EE/DRSP. IMPLICATIONS STATEMENT Treatment with E4 15 mg/DRSP 3 mg showed complete ovulation inhibition, despite less suppression of follicle-stimulating hormone and luteinizing hormone compared to EE/DRSP. If it becomes commercially available, E4/DRSP, containing a naturally occurring estrogen, should be as effective as EE/DRSP.
Collapse
Affiliation(s)
| | | | - Virginie Kinet
- Estetra SRL, an affiliate's company of Mithra Pharmaceuticals, Liège, Belgium
| | - Maud Jost
- Estetra SRL, an affiliate's company of Mithra Pharmaceuticals, Liège, Belgium.
| | - Adriana Bastidas
- Estetra SRL, an affiliate's company of Mithra Pharmaceuticals, Liège, Belgium
| | - Jean-Michel Foidart
- Estetra SRL, an affiliate's company of Mithra Pharmaceuticals, Liège, Belgium; University of Liège, Liège, Belgium
| |
Collapse
|
32
|
Aversa T, Corica D, Pepe G, Pajno GB, Valenzise M, Messina MF, Wasniewska M. Pubertal induction in girls with Turner Syndrome. Minerva Endocrinol (Torino) 2021; 46:469-480. [PMID: 33435643 DOI: 10.23736/s2724-6507.20.03285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Turner Syndrome (TS) is the most common female sex chromosome aneuploidy in females, and patients may present with hypergonadotropic hypogonadism due to gonadal dysgenesis. Timing and modalities of pubertal induction in these patients is still a matter of debate. Aim of this review was to focus on the latest update on pubertal induction in TS. Based on literature data, the following practical approach to this issue is recommended. Pubertal induction should begin between 11 and 12 years of age, starting with low doses of estradiol to preserve height potential. Transdermal 17β-Estradiol (17β-E2) could represent the first-choice induction regimen as it is more physiologic compared to an oral regimen and avoids the first-pass mechanism in the liver. In the case of poor compliance, administration of oral 17β-E2 or ethinyl estradiol could be offered. Incremental dose increases, approximately every 6 months, can contribute to mimic normal pubertal progression until adult dosing is reached over a 2- to 3-year period. Progestin should be added once breakthrough bleeding occurs or after 2 to 3 years of estrogen therapy or if ultrasound shows a mature uterus with thick endometrium. Treatment needs to be individualized and monitored by clinical assessment in relation to patient compliance and satisfaction. Well-designed prospective randomized clinical trials aimed to identify the best estrogen regimen for pubertal induction in TS girls are needed.
Collapse
Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy -
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni B Pajno
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria F Messina
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| |
Collapse
|
33
|
Totaro M, Palazzi S, Castellini C, Parisi A, D’Amato F, Tienforti D, Baroni MG, Francavilla S, Barbonetti A. Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study. Front Endocrinol (Lausanne) 2021; 12:741866. [PMID: 34880832 PMCID: PMC8647165 DOI: 10.3389/fendo.2021.741866] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/20/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy. METHODS A thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane's Q and I2. RESULTS The eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76). CONCLUSIONS The overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].
Collapse
Affiliation(s)
- Maria Totaro
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Sara Palazzi
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Chiara Castellini
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Parisi
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Federica D’Amato
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Daniele Tienforti
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Marco Giorgio Baroni
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Sandro Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- *Correspondence: Arcangelo Barbonetti,
| |
Collapse
|
34
|
Yen H, Chang YT, Yee FJ, Huang YC. Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. Am J Clin Dermatol 2021; 22:11-23. [PMID: 33048332 DOI: 10.1007/s40257-020-00565-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne is one of the cutaneous manifestations of polycystic ovary syndrome (PCOS). There is limited evidence on metformin use for treatment of acne in PCOS patients. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to evaluate the efficacy of metformin for treatment of PCOS-related acne. METHODS On November 23, 2019, we searched PubMed, the Cochrane Library, and Embase databases for human clinical studies in any language. The keywords included 'acne' and 'polycystic ovary syndrome' combined with 'metformin,' 'biguanide,' or 'glucophage.' We included randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and open-label studies on patients with PCOS treated with metformin. We calculated standardized mean differences (SMDs) for acne scores and odds ratios (ORs) for presence of acne, with 95% confidence intervals (CIs). Quality assessment was performed using the Cochrane Collaboration risk of bias instrument for RCTs. NRCTs and open-label studies were assessed using the adapted methodological index for nonrandomized studies (MINORS). RESULTS We included 51 studies on 2405 PCOS patients. Metformin as adjuvant therapy led to greater improvement of acne scores than the same therapy without metformin (SMD - 0.256; 95% CI - 0.439 to - 0.074). Pooling pre- and post-metformin therapy data showed significant decrease of acne scores after metformin use (SMD - 0.712; 95% CI - 0.949 to - 0.476). Presence of acne decreased significantly after metformin treatment (OR 0.362; 95% CI 0.271 to 0.485). LIMITATIONS There was heterogeneity across some studies due to different acne assessment scales, metformin dosages, and treatment durations. CONCLUSIONS For PCOS patients, metformin as stand-alone or adjuvant therapy was associated with improvement of acne. More randomized controlled trials are needed to validate these results. REGISTRATION PROSPERO registration number CRD42020159656.
Collapse
Affiliation(s)
- Hsuan Yen
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
| | - Yu-Tung Chang
- Department of Medical Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fui-Jun Yee
- Department of Medical Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
35
|
Hughan KS, Daley T, Rayas MS, Kelly A, Roe A. Female reproductive health in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S95-S104. [PMID: 31679735 DOI: 10.1016/j.jcf.2019.08.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
Women with cystic fibrosis (CF) are living longer and healthier lives, and opportunities for childbearing are increasingly promising. However, this population can also face sexual and reproductive health concerns, including menstrual irregularities, unplanned pregnancies, infertility and pregnancy complications. Additionally, more women are entering menopause and are at risk for the consequences of estrogen deficiency. The exact mechanisms involved in female reproductive health conditions in CF are not clearly understood, but are thought to include cystic fibrosis transmembrane regulator (CFTR)-mediated abnormalities, changes in female sex hormones, and other CF health-related factors. In the era of CFTR modulator therapy, new data are necessary to understand the impact of CFTR modulation on contraceptive effectiveness, fertility, and pregnancy outcomes to help guide future clinical care. This article reviews the current scientific knowledge of major reproductive health issues for women with CF.
Collapse
Affiliation(s)
- Kara S Hughan
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, USA.
| | - Tanicia Daley
- Division of Pediatric Endocrinology and Metabolism, Emory Children's Pediatric Institute, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA, USA
| | - Maria Socorro Rayas
- Division of Pediatric Endocrinology and Diabetes, University of Texas Health San Antonio, 7703 Floyd Curl, San Antonio, TX, USA
| | - Andrea Kelly
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Philadelphia, PA, USA
| | - Andrea Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA, USA
| |
Collapse
|
36
|
Florio KL, Kao M, Johnson T, Tuttle HA, White D, Nelson L, Patel N, Ramaeker D, Kendig S, Schmidt L, Grodzinsky A, Economy K. Contraception for the Cardiac Patient: a Cardiologist’s Primer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Purpose of review
Cardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for providers caring for women with heart disease.
Recent findings
Specific recommendation for the use of either non-hormonal or hormonal contraception requires knowledge of the types of contraceptive options available, cost, failure rates, and contraindications to use. Newer progestin-only options have become available and should be considered first-line therapy for women with cardiovascular disease.
Summary
The physiologic burden of pregnancy on the cardiovascular system can cause significant maternal morbidity and mortality for women with underlying CVD. These women should be offered safe and effective options for birth control, and both cardiology and obstetrical providers alike should possess fundamental knowledge of appropriate options.
Collapse
|
37
|
Campesi I, Montella A, Sotgiu G, Dore S, Carru C, Zinellu A, Palermo M, Franconi F. Combined oral contraceptives modify the effect of smoking on inflammatory cellular indexes and endothelial function in healthy subjects. Eur J Pharmacol 2020; 891:173762. [PMID: 33253680 DOI: 10.1016/j.ejphar.2020.173762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
Little information is available on the influence of sex in combination with smoking habits and combined oral contraceptives (COC) use on cellular inflammatory indexes such as neutrophil/lymphocyte ratio (NLR), derived NRL (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), mean platelet volume/platelet count (MPV/PLT), aggregate inflammation systemic index (AISI), and systemic inflammation response index (SIRI), which are cost-effective biomarkers to assessing inflammation. Therefore, the effect of COC was studied alone or in association with smoking and compared with results from healthy COC-free women and men. Furthermore, the association of cellular inflammatory indexes with endothelial function (arginine (Arg), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and lipid peroxidation (malondialdehyde MDA) biomarkers was evaluated. Blood was collected for hematological and biochemical analysis, which were used to calculate PLR, NLR, dNLR, MLR, MPV/PLT, AISI, and SIRI. Serum samples were assayed for Arg, ADMA, SDMA, and MDA. Monocytes, MLR, SIRI, and MPV/PLT were higher in men, while PLT count was higher in women. COC use increased lymphocytes and lowered PLR and MLR. Smoking reduced sexually divergent parameters, especially in COC users: smoking and non-smoking COC-free women displayed six divergent parameters, while COC users displayed only two (monocytes and MPV). In addition, COC affected endothelial function, reducing ADMA and Arg. Moreover, COC-free women had lower Arg levels than men. In conclusion, COC use strongly influence the effects of tobacco smoking, which are sex and parameter specific. Further, these data stress that COC use and smoking attitude select different cohorts indicating that sex and gender studies need intersectionality.
Collapse
Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università Degli Studi di Sassari, 07100, Sassari, Italy; Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy.
| | - Andrea Montella
- Dipartimento di Scienze Biomediche, Università Degli Studi di Sassari, 07100, Sassari, Italy; Unità Operativa di Genetica e Biologia Dello Sviluppo, Azienda Ospedaliero Universitaria di Sassari, 07100, Sassari, Italy
| | - Giovanni Sotgiu
- Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università Degli Studi di Sassari, 07100, Sassari, Italy
| | - Simone Dore
- Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università Degli Studi di Sassari, 07100, Sassari, Italy
| | - Ciriaco Carru
- Dipartimento di Scienze Biomediche, Università Degli Studi di Sassari, 07100, Sassari, Italy
| | - Angelo Zinellu
- Dipartimento di Scienze Biomediche, Università Degli Studi di Sassari, 07100, Sassari, Italy
| | - Mario Palermo
- Unità Operativa di Endocrinologia, Azienda Ospedaliero Universitaria di Sassari, 07100, Sassari, Italy
| | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy
| |
Collapse
|
38
|
Abstract
IMPORTANCE Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. OBSERVATIONS PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Risk factors for venous thromboembolism (VTE), such as older age, malignancy (cumulative incidence of 7.4% after a median of 19 months), inflammatory disorders (VTE risk is 4.7% in patients with rheumatoid arthritis and 2.5% in those without), and inherited thrombophilia (factor V Leiden carriers with a 10-year cumulative incidence of 10.9%), are associated with higher risk of VTE. Patients with signs or symptoms of lower extremity DVT, such as swelling (71%) or a cramping or pulling discomfort in the thigh or calf (53%), should undergo assessment of pretest probability followed by D-dimer testing and imaging with venous ultrasonography. A normal D-dimer level (ie, D-dimer <500 ng/mL) excludes acute VTE when combined with a low pretest probability (ie, Wells DVT score ≤1). In patients with a high pretest probability, the negative predictive value of a D-dimer less than 500 ng/mL is 92%. Consequently, D-dimer cannot be used to exclude DVT without an assessment of pretest probability. Postthrombotic syndrome, defined as persistent symptoms, signs of chronic venous insufficiency, or both, occurs in 25% to 50% of patients 3 to 6 months after DVT diagnosis. Catheter-directed fibrinolysis with or without mechanical thrombectomy is appropriate in those with iliofemoral obstruction, severe symptoms, and a low risk of bleeding. The efficacy of direct oral anticoagulants-rivaroxaban, apixaban, dabigatran, and edoxaban-is noninferior to warfarin (absolute rate of recurrent VTE or VTE-related death, 2.0% vs 2.2%). Major bleeding occurs in 1.1% of patients treated with direct oral anticoagulants vs 1.8% treated with warfarin. CONCLUSIONS AND RELEVANCE Greater recognition of VTE risk factors and advances in anticoagulation have facilitated the clinical evaluation and treatment of patients with DVT. Direct oral anticoagulants are noninferior to warfarin with regard to efficacy and are associated with lower rates of bleeding, but costs limit use for some patients.
Collapse
Affiliation(s)
- Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
- EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Ida Ehlers Albertsen
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
39
|
Khialani D, Rosendaal F, Vlieg AVH. Hormonal Contraceptives and the Risk of Venous Thrombosis. Semin Thromb Hemost 2020; 46:865-871. [DOI: 10.1055/s-0040-1715793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractThe risk of venous thrombosis (VT) varies according to the type of progestogen that is found in combined oral contraceptives (COCs). When combined with the estrogen component ethinylestradiol (EE), the androgenic progestogens are better able to counteract the EE-induced stimulation of liver proteins and hence are associated with a twofold decreased risk of VT compared with non- or antiandrogenic progestogens, which exert limited counteraction of EE. Because EE is responsible for the increased risk, novel estrogens such as estradiol were developed and seem to have a lower risk of VT than EE. Besides COCs, there are other methods of hormonal contraceptives, such as progestogen-only contraceptives, which do not increase VT risk, except for injectables. Other nonoral contraceptives are combined vaginal rings and patches. There is insufficient evidence regarding the risk of VT associated with these two methods compared with COCs. The increased risk associated with COCs is more pronounced in women with inherited thrombophilia. In these women, the progestogen levonorgestrel seems to be associated with the lowest risk of VT. Currently, there are no studies that have investigated the risk of VT in women who switch COCs. We hypothesize that switching COCs, even when switching from a high- to a low-risk COC, increases the risk of VT. Finally, risk prediction models in women who use COCs are lacking. Since there is a large number of VT cases associated with COC use, it is important to identify women at risk of VT and advise them on alternative contraception methods.
Collapse
Affiliation(s)
- Deeksha Khialani
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
40
|
Obesity and hormonal contraception: an overview and a clinician's practical guide. Eat Weight Disord 2020; 25:1129-1140. [PMID: 31515745 DOI: 10.1007/s40519-019-00774-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The growing prevalence of obesity among the fertile female population poses a considerable problem to contraceptive providers. Obese women, who are more at risk for venous thromboembolism and cardiovascular events due to their condition, might be at an even higher risk of developing thromboembolic events when on medical contraception. Combined hormonal contraceptives might be less effective in obese women and may lead to unacceptable metabolic side effects for this population. In addition, the lack of safety data for weight loss drugs and the higher risk for complications during and after pregnancy require a close surveillance of the fertility status of obese patients. OBJECTIVE The aim of this narrative review is to summarize the available medical contraceptive options and to give the readers a practical guidance for a wise contraceptive choice with regards to obesity. METHODS A general literature review of peer-reviewed publications on the topic "obesity and contraception" was performed using the PubMed database. RESULTS Nowadays, there are many useful tools that help clinicians in choosing among the wide range of therapeutic possibilities, such as the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use. Furthermore, the great diversity of hormonal contraceptive formulations (combined hormonal formulations; progestin-only methods) and active substances (different estrogens and progestins) allow physicians to tailor therapies to patients' clinical peculiarities. CONCLUSION Long-acting reversible contraceptives [progestin-only implants, levonorgestrel-intra-uterine devices (IUDs) and copper IUDs] and progestin-only methods in general are excellent options for many categories of patients, including obese ones. LEVEL OF EVIDENCE V, narrative review.
Collapse
|
41
|
Brull EP, Fernandes A, Monteiro I, Bahamondes L, Juliato CRT. Safety and bleeding patterns of the levonorgestrel 52-mg intrauterine system among women with thrombosis or coagulopathy. Int J Gynaecol Obstet 2020; 151:355-361. [PMID: 32966599 DOI: 10.1002/ijgo.13378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/10/2020] [Accepted: 09/14/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the safety of the levonorgestrel 52-mg intrauterine system (LNG-IUS) in women with a history of thrombosis or coagulopathy and to evaluate bleeding patterns. METHODS A retrospective chart review was conducted of 117 women attending a clinic between 2007 and 2019. Their sociodemographic characteristics, hematologic status, reasons for using LNG-IUS, duration of use, use of oral anticoagulants, complications, and bleeding patterns were analyzed. RESULTS Ninety-nine women had a history of thrombosis (71.7% in use of oral anticoagulants) and 18 had coagulopathies. No bleeding or any other complications occurred during placement of the LNG-IUS. Around two-thirds of the women reported amenorrhea or oligomenorrhea at 12, 24, and 54 months of follow-up, with no difference between the groups using the IUS for contraception or to treat heavy menstrual bleeding (HMB) (P=0.07), those with a history of thrombosis or coagulopathy (P=0.53), and users or non-users of oral anticoagulants (P=0.59). CONCLUSION The LNG-IUS is safe for women with hematologic disorders. It was associated with amenorrhea or oligomenorrhea in a large proportion of users up to 54 months of follow-up regardless of use of oral anticoagulants, reason for use of LNG-IUS (contraception or HMB), or history of coagulopathy or thrombosis.
Collapse
Affiliation(s)
- Eliza P Brull
- Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, SP, Brazil
| | - Arlete Fernandes
- Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, SP, Brazil
| | - Ilza Monteiro
- Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, SP, Brazil
| | - Luis Bahamondes
- Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, SP, Brazil
| | - Cassia R T Juliato
- Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, SP, Brazil
| |
Collapse
|
42
|
A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive. Clin Drug Investig 2020; 40:395-420. [PMID: 32162237 DOI: 10.1007/s40261-020-00901-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The levonorgestrel oral emergency contraceptive is well tolerated and effective, however its use is still limited, mainly due to safety concerns. OBJECTIVE This systematic review and meta-analysis aimed to summarize current evidence regarding the adverse events, and their prevalence, reported during the use of oral levonorgestrel emergency contraceptives. METHODS Four electronic databases and the US FDA Adverse Event Reporting System (FAERS) Public Dashboard were searched. Studies that reported or investigated safety outcomes or adverse reactions during the use of levonorgestrel as an emergency oral contraceptive were included. Data on study design, demographics of levonorgestrel and the control cohort, and reported adverse effects were extracted. RESULTS A total of 47 articles were included in this systematic review, from which it was shown that most of the adverse reactions were common and not serious. Uncommon adverse reactions identified included anorexia, ectopic pregnancy, exanthema, chloasma, miscarriage, and weight gain. Multiple serious adverse events, including convulsion, ectopic pregnancy, febrile neutropenia, stroke, abdominal hernia, anaphylaxis, cancer, ovarian cyst rupture, serious infections, and suicidal ideation, were reported. In addition, the prevalence of adverse events after a levonorgestrel 0.75 mg two-dose regimen and a levonorgestrel 1.5 mg single-dose regimen were not statistically different (p > 0.05). CONCLUSIONS The most common adverse effects of levonorgestrel were not serious. This systematic review shows that data regarding the adverse reactions of repeated use of levonorgestrel are scarce. Studies on the multiple uses of levonorgestrel emergency contraception are still required to ensure its safety.
Collapse
|
43
|
Riedinger CJ, Zite NB, Overby DW, Robinson EF, Moulder JK. Optimizing contraceptive access for women undergoing bariatric surgery. Surg Obes Relat Dis 2020; 16:2082-2087. [PMID: 33004300 DOI: 10.1016/j.soard.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
With the dramatic increase in the prevalence of obesity, there is a corresponding increase in surgical procedures to treat obesity. Reproductive aged women (18-45 years old) undergo half of the bariatric surgical procedures performed in the United States each year. These women experience profound physiologic changes in response to bariatric surgery, including dramatic changes in reproductive function. Current guidelines recommend delaying attempts at conception for 12-24 months after bariatric surgery during the time of most profound weight loss. Despite these recommendations, many women report unprotected intercourse during this time, and many use less efficacious contraceptive options. Herein, we address contraceptive considerations in women of reproductive age who undergo bariatric surgery and opportunities to maximize a multidisciplinary surgical approach to optimize their overall health.
Collapse
Affiliation(s)
- Courtney J Riedinger
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - David Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Erica F Robinson
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janelle K Moulder
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
44
|
Glintborg D, Andersen M. Medical treatment and comorbidity in polycystic ovary syndrome: An updated review. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.coemr.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
45
|
NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause. ACTA ACUST UNITED AC 2020; 27:735-745. [PMID: 32433263 DOI: 10.1097/gme.0000000000001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.
Collapse
|
46
|
Ciriello D, Cieri-Hutcherson N. Pharmacists and Contraception in the Inpatient Setting. PHARMACY 2020; 8:pharmacy8020082. [PMID: 32397460 PMCID: PMC7356798 DOI: 10.3390/pharmacy8020082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
The choice of contraceptive method should be based on patient specific factors, patient preference, and method-specific properties. In this article, we review opportunities for an inpatient clinical pharmacist to assist in the selection and counseling of contraceptives in hospitalized patients. An inpatient pharmacist has the opportunity to discuss various contraceptive methods with the patient, ensuring an appropriate method is used after discharge, which is especially important after the occurrence of a contraception-related adverse effect or contraindication to certain contraceptive methods. Barriers, such as formulary restrictions, can limit inpatient initiation of contraceptive therapy while hospitalized, but pharmacists can provide education on appropriate alternatives. Inpatient clinical pharmacists can also make recommendations for contraceptive methods in special populations. It is crucial to select an appropriate therapy in patients with an underlying medical condition, such as those with active or history of breast cancer, psychiatric disorder, or thrombophilia, as inappropriate therapy can cause an increased risk of harm. Pharmacists can assist in contraceptive counseling, evaluating for drug-drug and drug-disease interactions, and recommending the most appropriate therapy in special populations. An inpatient pharmacist has the opportunity to interact with the medical team and assist in navigation of teratogenic medication use and Risk Evaluation and Mitigation Strategies.
Collapse
Affiliation(s)
| | - Nicole Cieri-Hutcherson
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Correspondence:
| |
Collapse
|
47
|
Wang Y, Li J, Wang H, Wang X. Vaginal repaired cesarean section diverticulum is beneficial in women with two prior cesarean sections. BMC WOMENS HEALTH 2020; 20:81. [PMID: 32326910 PMCID: PMC7181476 DOI: 10.1186/s12905-020-00940-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 04/06/2020] [Indexed: 11/10/2022]
Abstract
Background The aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs). Methods From January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound. Results A total of 221 (89.11%) women were followed-up for more than 3 months, and 168 (67.74%) women were followed-up for more than 6 months. There were significant differences in the average duration of menstruation (7.77 ± 2.05 and 8.02 ± 2.06 days VS 13.99 ± 3.71 days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18 mm VS 7.99*12.43*6.62 mm) and the TRM (7.61 ± 2.52 and 7.60 ± 3.00 mm VS 2.51 ± 1.02 mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P < 0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P > 0.05). Conclusion In CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.
Collapse
Affiliation(s)
- Yizhi Wang
- Departments of Gynecology and Obstetrics, Xin Hua Hospital Affiliated with Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China
| | - Jiarui Li
- Departments of Gynecology and Obstetrics, Xin Hua Hospital Affiliated with Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China
| | - Husheng Wang
- Departments of Gynecology and Obstetrics, Xin Hua Hospital Affiliated with Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
| | - Xipeng Wang
- Departments of Gynecology and Obstetrics, Xin Hua Hospital Affiliated with Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
| |
Collapse
|
48
|
Schrager S, Larson M, Carlson J, Ledford K, Ehrenthal DB. Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women. J Womens Health (Larchmt) 2020; 29:937-943. [PMID: 32155101 DOI: 10.1089/jwh.2019.7731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Contraceptives that contain estrogen and/or progestins are used by millions of women around the world to prevent pregnancy. Owing to their unique physiological mechanism of action, many of these medications can also be used to prevent cancer and treat multiple general medical conditions that are common in women. We performed a comprehensive literature search. This article will describe the specific mechanisms of action and summarize the available data documenting how hormonal contraceptives can prevent ovarian and uterine cancer and be used to treat women with a variety of gynecological and nongynecological conditions such as endometriosis, uterine fibroids, heavy menstrual bleeding, polycystic ovary syndrome, acne, and migraines. Contraceptive methods containing estrogen and progestin can be used for a wide variety of medical issues in women.
Collapse
Affiliation(s)
- Sarina Schrager
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Magnolia Larson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jensena Carlson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kathryn Ledford
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Deborah B Ehrenthal
- Department of Obstetrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Gynecology and Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
49
|
Pyra M, Casimiro I, Rusie L, Ross N, Blum C, Keglovitz Baker K, Baker A, Schneider J. An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy. Transgend Health 2020; 5:1-9. [PMID: 32322683 PMCID: PMC7173689 DOI: 10.1089/trgh.2019.0061] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: Given evidence from cisgender patients that sex hormones can impact risk for some forms of cardiovascular disease (CVD), there are concerns regarding CVD among transgender patients using gender-affirming hormone therapy (HT). Methods: Using a retrospective cohort at a U.S. urban federally qualified health center (FQHC) focused on sexual and gender minority health, we examined associations between HT in transgender patients and two specific CVD outcomes, hypertension (HTN) and thromboembolism (TE). We assessed outcomes by ICD-10 codes in electronic medical records (EMR) of 4402 transgender patients. Hormone use was assessed both by blood concentrations and by prescriptions, from EMR. Results: Nineteen transwomen (TW) (0.8%) had a TE and 49 (2.1%) developed HTN; among transmen (TM), 27 (1.5%) developed HTN and there were no significant associations between hormones and HTN. Among transwomen, there was no association between TE and HT as assessed by blood concentrations. However, recent progestin prescriptions were associated with an increased odds of TE (adjusted odds ratio [aOR] 2.95 [95% confidence interval; CI 1.02-8.57]), with possibly differential effects for medroxyprogesterone acetate versus micronized progesterone. Higher total testosterone blood concentrations were associated with greater odds of HTN in TW (aOR 1.16 [95% CI 1.01-1.33]), after controlling for body mass index. Among TW, ever having a progestin prescription was protective for HTN (aOR 0.36 [95% CI 0.15-0.87]). Conclusion: We found no associations between HT and HTN among TM, More research is needed to examine the effect of recent progestin, specifically medroxyprogesterone acetate, on TE among transwomen. The protective association between progestins and HTN among TW is reassuring.
Collapse
Affiliation(s)
- Maria Pyra
- Howard Brown Health Center, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| | - Isabel Casimiro
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, Chicago, Illinois
| | - Laura Rusie
- Howard Brown Health Center, Chicago, Illinois
| | - Nat Ross
- Howard Brown Health Center, Chicago, Illinois
| | - Cori Blum
- Howard Brown Health Center, Chicago, Illinois
| | | | - Andie Baker
- Howard Brown Health Center, Chicago, Illinois
| | - John Schneider
- Howard Brown Health Center, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| |
Collapse
|
50
|
Li L, Zhang R, Zeng J, Ke H, Peng X, Huang L, Zhang H, Chen Z, Li TT, Tan Q, Yang Y, Li X, Li X. Effectiveness and safety assessment of drospirenone/ethinyl estradiol tablet in treatment of PCOS patients: a single center, prospective, observational study. BMC WOMENS HEALTH 2020; 20:39. [PMID: 32106860 PMCID: PMC7047377 DOI: 10.1186/s12905-020-00905-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 02/14/2020] [Indexed: 01/09/2023]
Abstract
Background To investigate the effectiveness and safety of 3 mg drospirenone and 20 μg ethinyl estradiol tablet (3 mg DRSP/20 μg EE) in the treatment of polycystic ovary syndrome (PCOS). Methods This single center, prospective observational study was conducted in 140 patients with PCOS. They were prescribed 3 mg DRSP/20 μg EE in a 24/4/ regimen for 3 months. Patients were instructed to take oral DRSP/EE tablets (once daily) on the 2nd day of menstruation, for 28 consecutive days for 1 cycle. After 3 months of treatment, anthropometric assessments along with variations in sex hormones related index, glucolipid metabolic index, changes in bilateral ovarian volume, as well as adverse effect of the combination were evaluated. Results When compared to baseline, body mass index (BMI, 22.07 ± 4.09 vs. 21.35 ± 3.22, p < 0.001) and waist hip ratio (WHR, 0.86 ± 0.07 vs. 0.854 ± 0.06, p = 0.026) decreased significantly after treatment. Sex-hormones such as luteinizing hormone (LH) (10.88 vs. 5.81 U/L), testosterone (T) (1.85 vs. 1.51 nmol/L) and free androgen index (FAI) (5.37 vs. 1.50) decreased significantly after treatment (p < 0.001). Follicular stimulating hormone (FSH) increased significantly at 3 months as compared to before treatment (5.13 vs. 5.42 U/L, p = 0.009). Plasma insulin (11.03 vs. 11.10 pmol/L), fasting (4.97 vs. 4.93 mmol/L) and 2 h-blood glucose levels (7.18 vs. 7.04 mmol/L) did not change when compared to baseline. Plasma triglycerides (TG, 1.32 vs. 1.65 mmol/L) significantly increased 3 months after treatment when compared to before treatment (p < 0.001). However, high density lipoprotein-cholesterol (HDL-C) levels increased significantly after treatment (1.41 vs. 1.57 mmol/L, p < 0.001). It was seen that, when compared to baseline, bilateral ovarian volume (left and right) was significantly lower after treatment (p < 0.05). It was seen that 81 patients reported no adverse reactions. Of the common discomforts reported, breast swelling and pain, gastrointestinal disorder and dizziness and headache were most frequent. Conclusions Treatment of PCOS patients with3 mg DRSP/20 μg EE has shown beneficial hormonal and lipid profile along with considerable safety profile. Trial registration Chinese Clinical Trial Registry ChiCTR1900022001, March 2019, retrospectively registered.
Collapse
Affiliation(s)
- Li Li
- Guangdong Women and Children Hospital, Guangzhou, 510010, China.
| | - Ruiqin Zhang
- Guangzhou Medical University, Guangzhou, 510182, China
| | - Jing Zeng
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Hu Ke
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Xiuhong Peng
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Liying Huang
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Hongmei Zhang
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Zhijing Chen
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Tian Tian Li
- Guangdong Women and Children Hospital, Guangzhou, 510010, China
| | - Qiuxiao Tan
- Guangzhou Medical University, Guangzhou, 510182, China
| | - Ying Yang
- Guangzhou Medical University, Guangzhou, 510182, China
| | - Xiaofang Li
- Guangzhou Medical University, Guangzhou, 510182, China
| | - Xin Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
| |
Collapse
|