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Abstract
INTRODUCTION Short-term and long-term steroid contraceptive systems are widely employed in adolescents and premenopausal women; they could induce variation in bone metabolism, but whether these changes increase the overall fracture risk is not yet clear. EVIDENCE ACQUISITION A systematic search of scientific publications about "hormonal contraceptives" and "bone metabolism" in reproductive age women was conducted. EVIDENCE SYNTHESIS In adolescent girl, combined oral contraceptives could have a deleterious effect on bone health when their onset is within three years after menarche and when they contain ethinyl estradiol at the dose of 20 mcg. In perimenopausal women, steroid contraceptives seem not influence bone health nor increase osteoporotic fractures risk in menopause. The oral progestogens intake is not related to negative effects on skeletal health. Depot medroxyprogesterone acetate (DMPA) induce a prolonged hypoestrogenism with secondary detrimental effect on healthy bone; the higher bone loss was observed at the DMPA dose of 150 mg intramuscular such as after long-term DMPA-users. Progestin-based implants and intrauterine devices have not negative effect on bone health. CONCLUSIONS Since sex-steroid drugs induce variations in hormonal circulating concentrations, they may negatively affect bone metabolism. Contraceptive choice should be tailored evaluating any possible effect on bone health. Clinicians should always perform a precontraceptive counselling to identify any coexisting condition that may affect bone health. Further randomized studies are needed to confirm these results.
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Affiliation(s)
- Morena L Rocca
- Operative Unit of Obstetrics and Gynecology, Pugliese-Ciaccio Hospital, Catanzaro, Italy -
| | - Anna R Palumbo
- Department of Obstetrics and Gynecology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giovanna Bitonti
- Department of Obstetrics and Gynecology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Caterina Brisinda
- Department of Obstetrics and Gynecology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Costantino DI Carlo
- Department of Obstetrics and Gynecology, Magna Græcia University of Catanzaro, Catanzaro, Italy
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DI Carlo C, Abbondanza M, Agnello A, Cavalli G, Driul L, Petriglia M, Tinelli A, Tirelli A, Tusei A, Grandi G. Current and future hormonal contraception in Italy: results from an Italian consensus expert meeting. Minerva Obstet Gynecol 2021; 73:614-620. [PMID: 34751529 DOI: 10.23736/s2724-606x.21.04897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hormonal pills are among the most widely contraceptive methods used by women, despite the possible onset of different adverse events. To minimize the risk of thrombosis-related adverse events, different formulations and doses have been investigated. Micronized estradiol (E2)/nomegestrol acetate (NOMAC) 24+4 is the first monophasic combined oral contraceptive pill containing natural E2, the same steroid produced by the granulosa cells of women ovaries. This combination presents an improved effect on hemostasis and metabolism compared to ethinyl-estradiol (EE)-based products and may be considered a good option to meet women's needs in a more physiological way. Despite the benefits of E2, its use is still not so common among combined oral contraceptives (COC). METHODS Seventy-seven Italian gynecologists were involved and asked to answer a survey to investigate some aspects related to contraception. The results of the survey were discussed within the same gynecologists and a panel of experts during eight macro-regional meetings. RESULTS The survey demonstrated that clinicians dedicate 40-60% of their time to contraception and confirmed the importance of the choice of the contraceptive pill, which is mostly prescribed for contraceptive purposes. Moreover, COC containing E2 is considered as the first choice in oral contraception and meets the features of an ideal pill. CONCLUSIONS Italian gynecologists reported that E2-based pill presents benefits related to safety, good tolerability, and low adverse events, in particular, related to a reduced thromboembolic risk. Research market data highlight that the use of these types of COC should expand with respect to traditional compounds containing EE.
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Affiliation(s)
- Costantino DI Carlo
- Department of Neurosciences and Reproductive Sciences, Federico II University, Naples, Italy
| | - Massimo Abbondanza
- Unit of Gynecology, ASL Città di Torino, Turin, Italy.,ASL TO5, Turin, Italy
| | | | - Giovanni Cavalli
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Lorenza Driul
- Unit of Obstetrics and Gynecology, University of Udine, Udine, Italy
| | - Massimo Petriglia
- Unit of Obstetrics and Gynecology, Velletri Hospital, Velletri, Rome, Italy
| | - Andrea Tinelli
- Unit of Obstetrics and Gynecology, Veris delli Ponti Hospital, Scorrano, Lecce, Italy
| | | | - Anna Tusei
- Unit of Obstetrics and Gynecology, Valduce Hospital, Como, Italy
| | - Giovanni Grandi
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
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Bitonti G, Clemente N, Del Fabro A, Manna P, Buttignol M, Cadel M, DI Carlo C, Giorda G, Zullo F, Sopracordevole F. CIN 2 in childbearing-age women: may colposcopy help in choosing the proper management? Minerva Obstet Gynecol 2021; 74:489-495. [PMID: 34180613 DOI: 10.23736/s2724-606x.21.04844-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND CIN2 is considered a biologically equivocal lesion falling between low and high grade cervical dysplasia, but it is often managed with cervical conization as a high-grade lesion. However, since cervical conization can lead to an increased risk of adverse obstetric events, it might be interesting to identify, by colposcopy, a subgroup of women with a low risk of "occult" CIN3 who could be managed with a "wait and see" approach. METHODS All the women with CIN2 cervical biopsy from 1999 to 2019 were retrospectively identified. Their colposcopic patterns at the time of biopsy and the histopathological findings on the final cone specimen were compared. RESULTS Among the 354 women with CIN2 biopsy included, the overall CIN3+ lesion rate on final cone specimen was 21.4%. The rate of CIN3 on final specimen was higher in women with G2 colposcopy compared to G1 (27,2% vs 15.9%, p= 0.01). Among women with G1 colposcopy, the rate of CIN3+ lesions was significantly higher in women with fine punctation (p=0.02) while no differences in women with thin acetowhite epithelium or fine mosaic emerged. CONCLUSIONS In women with CIN2 biopsy, when a G2 pattern or G1 with fine punctation on colposcopy is detected, there is an increased risk of CIN3+ on final histology, therefore an excisional treatment should be preferred. Otherwise, in women with CIN2 biopsy and other G1 patterns on colposcopy, a "wait and see" approach could be considered.
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Affiliation(s)
- Giovanna Bitonti
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Anna Del Fabro
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Paolo Manna
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Monica Buttignol
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Manuela Cadel
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Costantino DI Carlo
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Fulvio Zullo
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.,Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Napoli, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy -
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DE Leo V, Cianci A, DI Carlo C, Cappelli V, Fruzzetti F. [Customization of hormonal contraception]. Minerva Obstet Gynecol 2018; 70:1-26. [PMID: 29347814 DOI: 10.23736/s0026-4784.17.04157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last few years new oral contraceptives have been marketed showing a better safety profile for women. They are the result of important changes made to the old compounds. As far as the estrogenic component, with the aim of decreasing side effects, the dose of ethinyl estradiol has been reduced and synthetic estrogens have been replaced by natural estradiol, further improving the safety profile. Also the progestin component in the last years has been changed in terms of dose, endocrine and metabolic characteristics. Levonorgestrel is an androgenic progestin, but now there is the possibility of choosing progestins without androgenic effect (gestodene and desogestrel) or progestins with antiandrogenic effect (cyproterone acetate, dienogest, drospirenone, chlormadinone acetate), very useful in patients with hyperandrogenism. Some of these progestins, like Drospirenone, represented the real held contributing, because of its antimineralcorticoid action, to reduce an important side effect like fluid retention; moreover there is the possibility to choose products with high progestogen effect on endometrium (dienogest, nomegestrole acetate), resulting very effective in women with abnormal uterine bleedings. Also the regimens of administration have been changed, by shortening or eliminating the tablet-free period; in this way the women may avoid premenstrual symptoms. The oral is not the only route of administration, but today there are alternative routes like transdermal, transvaginal, intrauterine and subcutaneous, reducing gastro-intestinal interferences and possible mistakes in pill intake.
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MESH Headings
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Drug Design
- Estrogens/administration & dosage
- Estrogens/adverse effects
- Female
- Humans
- Progestins/administration & dosage
- Progestins/adverse effects
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Affiliation(s)
- Vincenzo DE Leo
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy -
| | - Antonio Cianci
- Department of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Costantino DI Carlo
- Department of Obstetrics and Gynecology, University of Catanzaro, Catanzaro, Italy
| | - Valentina Cappelli
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Franca Fruzzetti
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Venturella R, Vaiarelli A, Lico D, Ubaldi FM, Zullo F, DI Carlo C. A modern approach to the management of candidates for assisted reproductive technology procedures. Minerva Obstet Gynecol 2018; 70:69-83. [PMID: 28895679 DOI: 10.23736/s0026-4784.17.04138-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The growing use of assisted reproductive technologies (ART) and the incorrect information from mass media, determined in the public the wrong idea that the right moment of life for programming a pregnancy can be delayed well beyond the physiological fertile age. Spare and insufficient health authorities' interventions are driven to explain to the general population the reduction of the fertility potential of couples and particularly of women with advancing age. This situation, characterized by more and more women seeking for pregnancy after age 38-40 imposes to specialists in Reproductive Medicine an honest and transparent counselling. Today, more than ever, it is pertinent to talk about the need of an "ethic approach" to ART, by which the specialist takes care of all the aspects inherent to infertility, such as the strong motivations of the couples in searching a child, the wrong perception of ART infallibility, the incorrect advertising in the mass media about the pregnancy of elderly actresses and show-girls, and finally, the enormous amount of commercial interests revolving around the "business" of in-vitro fertilization. In this context, the ideal policy that an ART center should adopt entails the correct and rapid identification of the characteristics of the couple, the exploitation of women ovarian reserve to obtain the right number of high quality oocytes, the protection of patients' health, the identification of the embryos with the highest chances of implantation and the reduction of the time to pregnancy. Here we analyse how to obtain each of these goals, through a literature review and expert clinical opinion.
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Affiliation(s)
- Roberta Venturella
- Department of Obstetrics and Gynecology, Magna Graecia University, Catanzaro, Italy -
| | - Alberto Vaiarelli
- GENERA Center for Reproductive Medicine, Valle Giulia Clinic, Rome, Italy
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Daniela Lico
- Department of Obstetrics and Gynecology, Magna Graecia University, Catanzaro, Italy
| | - Filippo M Ubaldi
- GENERA Center for Reproductive Medicine, Valle Giulia Clinic, Rome, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynecology, Magna Graecia University, Catanzaro, Italy
| | - Costantino DI Carlo
- Department of Obstetrics and Gynecology, Magna Graecia University, Catanzaro, Italy
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Gambacciani M, Biglia N, Cagnacci A, Caruso S, Cicinelli E, DE Leo V, DI Carlo C, Farris M, Gambera A, Guaschino S, Lanzone A, Paoletti AM, Russo N, Vicariotto F, Villa P, Volpe A. Menopause and hormone replacement therapy: the 2017 Recommendations of the Italian Menopause Society. Minerva Obstet Gynecol 2017; 70:27-34. [PMID: 28975776 DOI: 10.23736/s0026-4784.17.04151-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last decade, the risk benefits ratio of hormone replacement therapy (HRT) has been reevaluated mainly in tens of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these recommendations is to provide a simple and updated reference on postmenopausal HRT. The term HRT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential, when progestogen is added to ERT for 10-14 days a month, or continuous combined when progestogen is administered continuously every day along with a fixed amount of estrogen, In the everyday language, HRT includes also tibolone and the tissue-selective estrogen complex.
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Affiliation(s)
- Marco Gambacciani
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy -
| | | | - Angelo Cagnacci
- Department of Obstetrics Gynecology and Pediatrics, Azienda Sanitaria Universitaria Integrata Udine, Udine, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, School of Medicine, University of Bari, Bari, Italy
| | - Vincenzo DE Leo
- Department of Obstetrics and Gynecology, University of Siena, Santa Maria le Scotte Polyclinic, Siena, Italy
| | - Costantino DI Carlo
- Department of Obstetrics and Gynecology, Magna Græcia University, Catanzaro, Italy
| | | | - Alessandro Gambera
- Department of Gynecological Endocrinology, University of Brescia, Brescia, Italy
| | | | - Antonio Lanzone
- Department of Obstetrics and Gynecology and Pediatrics, Sacro Cuore Catholic University, Rome, Italy
| | - Anna M Paoletti
- Department of Surgery, Obstetrics, and Gynecology, University of Cagliari, Cagliari University Hospital, Cagliari, Italy
| | | | | | - Paola Villa
- Department of Obstetrics and Gynecology and Pediatrics, Sacro Cuore Catholic University, Rome, Italy
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