One-year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives / Alterações na densidade mineral óssea e nos marcadores de formação óssea em adolescentes usuárias ou não de contraceptivos hormonais orais combinados por período de um ano

Abstract Objective: The objective of this study was to evaluate the effects of two low-dose combined oral contraceptives on bone metabolism in adolescents for one year. Methods: This was a quasi-experimental study. The adolescents were divided into three groups: oral contraceptives 1 (n = 42) (20 µg EE/150 µg desogestrel), oral contraceptives 2 (n = 66) (30 µg EE/3 mg drospirenone), and a control group (n = 70). Adolescents underwent anthropometric assessment and densitometry (dual-energy X-ray). Bone age and bone formation markers (osteocalcin and bone alkaline phosphatase) were evaluated. The oral contraceptives users were evaluated again after 12 months. Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group. Results: At study entry, no significant differences were observed between the oral contraceptives 1, oral contraceptives 2, and controls in the analyzed variables. Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year. There was a significant reduction in bone alkaline phosphatase levels; no significant difference was observed for osteocalcin in control individuals. Comparison of dual-energy X-ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups. A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups. Conclusion: Adolescent women gain peak bone mass during this phase of life. Two low-dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls.

Resumo: Objetivo: O objetivo deste estudo foi avaliar os efeitos de dois contraceptivos orais combinados de baixa dosagem por um ano sobre o metabolismo ósseo em adolescentes. Métodos: Este foi um estudo quase experimental. As adolescentes foram divididas em três grupos: contraceptivos orais 1 (n = 42) (20 µg de EE/150 µg de desogestrel), contraceptivos orais 2 (n = 66) (30 µg EE/3 mg de drospirenona) e grupo controle (n = 70). As adolescentes foram submetidas à avaliação antropométrica e densitometria (raio-X de dupla energia). Foram avaliados a idade óssea e os marcadores de formação óssea (osteocalcina e fosfatase alcalina óssea). As usuárias de contraceptivos orais foram novamente avaliadas após 12 meses. A análise de regressão linear foi utilizada para estudar, indiretamente, o efeito de cada ano adicional da idade cronológica sobre as variáveis antropométricas e densitométricas e sobre os marcadores ósseos no grupo de controle. Resultados: No início do estudo, não foram observadas diferenças significativas nas variáveis analisadas entre as usuárias de contraceptivos orais 1, contraceptivos orais 2 e o grupo controle. A análise de regressão linear mostrou um aumento na densidade mineral óssea e no conteúdo mineral ósseo para cada ano adicional. Houve uma redução significativa nos níveis de fosfatase alcalina óssea e não foi observada diferença significativa para osteocalcina nos indivíduos controles. A comparação das variáveis do raio-X de dupla energia no início e após um ano não mostrou diferença significativa no grupo de contraceptivos orais 1 ou contraceptivos orais 2. Foi observada uma redução significativa nos níveis de fosfatase alcalina óssea e osteocalcina nos dois grupos contraceptivos orais 1 e contraceptivos orais 2. Conclusão: As adolescentes atingiram o pico de massa óssea durante essa fase da vida. Duas formulações de contraceptivos hormonais orais de baixa dosagem, após um ano de uso, se associaram a menor incremento na densidade mineral óssea e menor concentração de marcadores de formação óssea quando confrontados com resultados de adolescentes não usuárias de contraceptivos.

Autoimmune progesterone dermatitis: A case report

Abstract Introduction Autoimmune progesterone dermatitis (APD) is a rare autoimmune dermatosis characterized by recurrent cutaneous and mucosal lesions during the luteal phase of the menstrual cycle that disappear some days after the menses. Case Report A 34-year-old primipara woman with no significant past medical history and no prior exogenous hormone use, who presented with cyclic skin eruptions starting 1 year after the delivery. The lesions occurred 6 days before the menses and disappeared in between 1 and 2 days after the menstruation ceased. The patient was diagnosed after a positive response to an intradermal test with progesterone and was successfully treated with combined oral contraceptives. The skin eruptions have not returned since the initiation of this therapy. Conclusion Dermatologists, gynecologists, and obstetricians should be aware of this rare entity. Furthermore, if this condition is suspected, a thorough history taking on the menstrual cycle and results of the intradermal progesterone test are mandatory.

Experiencia piloto con el uso extendido de un anticonceptivo oral combinado de baja dosis de estrógeno / Extended use of an oral combined contraceptive pill with low estrogen dose: pilot experience

Objetivo: Evaluar en una experiencia piloto la aceptabilidad y bienestar de la usuaria, después de un periodo de 12 meses de un anticonceptivo hormonal combinado oral de baja dosis estrogénica, con modalidad de uso extendido de 84 píldoras activas consecutivas, seguidas de 7 días de placebo. Método: Se incorporan 25 mujeres voluntarias que usan una combinación de 20 ug de etinilestradiol + 3 mg de drospirenona, con un tiempo de uso de 12 meses. En calendario de registro diario se consignan los días de sangrado o goteo genital así como todo tipo de fármaco ingerido. Al término de los 12 meses se efectúa una encuesta respecto al grado de satisfacción con la posología recibida. Resultados: 13 usuarias (52 por ciento) cumplen los 12 meses de uso. Todas ellas manifiestan un alto grado de conformidad, destacando las ventajas de presentar periodos menstruales ocasionales, mejoría marcada en la sintomatología compatible con el síndrome de tensión premenstrual con el consiguiente incremento del bienestar general. Siete usuarias (28 por ciento) no terminan el estudio por razones médicas, siendo 6 de estas por alteraciones de los flujos rojos y en 5 casos (20 por ciento) se producen retiros no médicos. Conclusión: Esta experiencia, que es la primera con la formulación descrita, confirma en un porcentaje de usuarias las bondades adicionales reportadas en las experiencias previas con otros productos similares, respecto al uso extendido de anticoncepción hormonal oral en un grupo de mujeres que deseaban espaciar sus periodos menstruales.

Objetives: A pilot study designed in order to know about the acceptability of an oral combined contraceptive pill, with low estrogen dose used in an extended way of 84 consecutive days, followed by 7 days of no pills ingestion during a scheduled follow up of 1 year. Methods: 25 volunteers women were recruited among those which wants to use oral combined contraceptive pills and who accepted this extended way of use. Combined contraceptive pills contains each 20 ug of ethinylestradiol plus 3 mg of drosperinone. At admission women were provided with menstrual diary cards in order to check all bleeding days plus any extra pharmaceutical compound received. At the end of the 12 months follow up an interview was done in order to know women experiences and acceptability of this extended way of use. Results: 52 percent of women end the study at the scheduled 12 months use. All of them feel that the main advantages of these extended way of use were to have few menstrual periods and improving premenstrual symtomatology with better quality of life. 7 women (28 percent) did not finish the study because of medical reasons being due in 6 of these for bleeding disturbances. Conclusions: This report is pioneer with the use this hormone combination in this extended type way of use. Results confirm previous positive reports experiences using another similar hormonal compounds with this extended way of use in women who want to reduce the interval of their menstrual periods.

Beneficios no anticonceptivos de 0, 02 mg de etinilestradiol/2 mg de acetato de clormadinona administrados en un régimen de 24+4 días / Non-contraceptive benefits of 0.02 mg ethinylestradiol /2 mg chlormadinone acetate in a 24 +4 days intake regimen

Objetivo: Demostrar la influencia sobre las molestias emocionales y físicas (beneficios no anticonceptivos) experimentadas durante el primer año de uso de un anticonceptivo oral combinado (AOC) que contiene 0,02 mg de etinilestradiol (EE) y 2 mg de acetato de clormadinona (ACM) administrado en un régimen de 24 + 4 días de placebo. Diseño del estudio: Análisis adicional de las sensaciones subjetivas registradas en los diarios de 1665 participantes de un estudio de Fase III multicéntrico, no controlado, de administración múltiple, después de 13 ciclos de EE/ACM en un régimen de administración de 24 + 4 días, publicado previamente. Resultados: Se informó de menor frecuencia de molestias emocionales y físicas en el ciclo de medicación 13 en comparación con los datos en la admisión y en el ciclo 1. La incidencia de ánimo depresivo se redujo en 84,5 por ciento y 72,2 por ciento respectivamente, y la irritabilidad en 87,3 por ciento y 66,0 por ciento. Las cefaleas se redujeron en 75,5 por ciento y 74,7 por ciento, las molestias mamarias en 77,1 por ciento y 66,1 por ciento, y la dismenorrea preexistente en 77,9 por ciento y 67,6 por ciento respectivamente. El abandono prematuro del estudio a causa de las molestias fue marginal, y el perfil del sangrado fue aceptable. Conclusiones: Un AOC de baja dosis que contiene 0,02 mg de EE + 2 mg de ACM, administrado en un régimen de 24 + 4 días, reduce significativamente la mayor parte de las molestias emocionales y físicas que se presentan durante los ciclos espontáneos de las mujeres, y se combina con un adecuado perfil de sangrado.

Objective: To demonstrate the influence on physical and psychological complaints during the first year of intake of the combined oral contraceptive (COC) 0.02 mg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA), administered in a regimen of 24 days of CMA/EE intake followed by 4 days of placebo intake. Study design: The subjective feelings of non-contraceptive benefits registered in women's diaries of 1,665 subjects participating in a multicentre, uncontrolled, multiadministration, Phase III trial, published elsewhere, were analyzed post-hoc after 13 cycles intake of EE/CMA in a 24 +4 days intake regimen. Results: Emotional complaints were reported less frequently at medication cycle 13 compared with admission and cycle 1. Depressive mood was reduced by 84.5 percent and 72.2 percent, irritability by 87.3 percent and 66.0 percent; physical complaints were also reduced: headaches by 75.5 percent and 74.7 percent, breast discomfort by 77.1 percent and 66.1 percent; pre-existing dysmenorrhea by 77.9 percent and 67.6 percent. Premature termination due to complaints was only marginal, the bleeding profile was accepted. Conclusions: The low-dose COC, 0.02 mg EE/2 mg CMA, administered in a 24 +4 day regimen, reduces significantly most of the emotional and physical complaints occurring during spontaneous cycles of women, combined with an adequate bleeding profile.

A clinical study of transdermal contraceptive patch in Thai adolescence women.

OBJECTIVE: To study cycle control, compliance and safety of a transdermal contraceptive patch in adolescent Thai women. MATERIAL AND METHOD: Fifty-eight healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 microg/day). All participants aged 16-20 years were invited to participate from the family planning clinic at King Chulalongkorn Memorial Hospital. Data were collected on adverse effects, perceived advantages and disadvantages, body weight, blood pressure, patch detachments and compliance. Data were analyzed using mean, percentage and student's t-test. RESULTS: The participants' average age was 19.4 years, height 158.8 cm, weight 51.8 kg, BMI 20.8 Kg/m2. The most location of patch application was the abdomen and the most adverse event was breast tenderness (31.0%) followed by application site reaction, nausea vomiting and headache respectively. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. There were no significant changes in body weight and blood pressure. The improvement of their facial acne was reported. There were no pregnancies during use and the adhesion of the contraceptive patch is excellent. Partial patch detachment was reported in only 6.9%. No completed patch detachment was found. CONCLUSION: The present study found an overall positive impression of a new transdermal contraceptive patch. The good compliance and few side effects were demonstrated. The adhesive patch contraceptive was excellent.

Experiencia chilena con el uso de un anticonceptivo oral combinado de acetato de clormadinona/etinilestradiol: estudio no intervencional / Efficacy, tolerability and safety of an oral contraceptive containing ethinylestradiol/chlormadinone acetate: the Chilean experience

Objetivos: Evaluar en mujeres chilenas, la eficacia, tolerabilidad y seguridad del anticonceptivo Belara® (Acetato de Clormadinona 2 mg y Etinilestradiol 0,03 mg) (ACM/EE). Métodos: Estudio no intervencional, multicéntrico, prospectivo, de 6 ciclos de seguimiento, evaluando efectividad anticonceptiva, estabilidad de ciclo, tolerabilidad, seguridad y acción sobre peso, piel y cabello. Resultados: ACM/EE fue tomado por 593 mujeres durante 3426 ciclos. Hubo 2 embarazos durante el seguimiento, uno voluntario y otro involuntario; en ninguno de los casos se consideró como falla del método. Durante el tratamiento se observó mejoría progresiva en la estabilidad del ciclo menstrual, sangrado intermenstrual, amenorrea y dismenorrea, con frecuencia de 4,5%, 1,4%, 2,5% y 11,6% al sexto ciclo, respectivamente. El porcentaje de mujeres con piel normal incrementó de 25,5% antes del tratamiento a 63,6% después de seis meses de administración continua de ACM/EE. El peso promedio se mantuvo estable durante el tratamiento. Los eventos adversos mas frecuentes fueron: cefalea (10,4%), aumento de peso (8,3%), mastalgia (6,1%) y trastornos del ánimo (2%). El 11% de las usuarias (n=63) suspendió ACM/EE antes de terminar los 6 meses de observación. El 97,2% de los médicos y 96,1% de las usuarias calificaron los resultados con ACM/EE como “buenos o muy buenos”. Conclusiones: Similar a los resultados reportados en la literatura europea, este estudio realizado en población chilena, confirma la eficacia, seguridad y tolerabilidad de ACM/EE así como los beneficios antiandrogénicos adicionales sobre piel y cabello, y su efecto neutral sobre el peso corporal.

Objectives: To evaluate the efficacy, tolerability and safety of the contraceptive Belara® (chlormadinone 2 mg/ethinylestradiol 0.03 mg; ACM/EE) in chilean women. Methods: Non interventional, multicentric, prospective, 6 cycles follow up trial, evaluating contraceptive efficacy, cycle stability, tolerability, safety, and effect on hair and skin. Results: AMC/EE was taken by 593 women for a total of 3426 cycles. Two pregnancies were reported during follow-up, one voluntary and the other involuntary; they were not considered failure of the method. Progressive improvement in cycle stability, intermenstrual bleeding, amenorrhea and dysmenorrhea occurred during the treatment period reaching 4.5%, 1.4%, 2.5% y 11.6% at the 6th cycle respectively. The percentage of women with normal skin increased from 25.5% prior to treatment, to 63.6%, after taking ACM/EE during six months. The average body weight was maintained throughout treatment. The most frequent adverse events were: headache (10.4%), weight increase (8.3%), breast tenderness (6.1%) and mood changes (2%). An 11% of users (n=63) discontinued the use of ACM/EE before completing the observational period of six months. A 97.2% of physicians and 96.1% of users qualified the results with ACM/EE as “good or very good”. Conclusions: Similar to the results reported in the European literature, this study in the Chilean population confirmed the efficacy, safety and tolerability of ACM/EE, together with its antiandrogenic benefits on skin and hair, and its neutral effect on body weight.

Comparison of cycle control and side effects between transdermal contraceptive patch and an oral contraceptive in women older than 35 years.

OBJECTIVE: To compare menstrual patterns and side effects between transdermal contraceptive patch and oral contraceptive use in Thai women over 35 years old. DESIGN: Open labeled randomized control trial. SETTING: Family Planning Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: Ninety-six women above the age of 35 years old were randomized to receive either transdermal contraceptive patch (n = 48) or oral contraceptive (n = 48). The patch regimen was three consecutive 7-day patches (21 days) followed by 1 patch-free week per cycle; the oral contraceptive contained with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg. RESULTS: There were no statistically significant differences between the two groups in terms of cycle length. The mean duration in the transdermal contraceptive group was longer than the COC group with statistically significant difference. More patients in the COC group experienced spotting than the transdermal contraceptive group. Neither amenorrhea nor pregnancies occurred in both groups. CONCLUSION: Transdermal contraceptive patch provides reliable contraceptive efficacy. It also provides good cycle control equal to COC in Thai women aged above 35 years old. However, a higher incidence of minor adverse effects such as breast tenderness and nausea were demonstrated when compared to oral contraceptive containing with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg.

Serum HDL-cholesterol in women using low dose oral contraceptives.

This study was done to appraise the effects of low-dose oral contraceptives (OCs) containing 30microgm ethinyl estradiol and 150microgm levonorgestrel on lipid metabolism by a lipid variable-serum HDL-cholesterol (HDL-C). HDL-C has been identified as a lipoprotein that protects against atherosclerosis and its levels are inversely proportional to the risk for developing ischemic coronary disease and venous thromboembolic disorders. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCs users for last one-year group, three-year group and five-year group. The result showed that there was no significant difference on serum HDL-cholesterol levels between users & non-users women. It is concluded that low-dose oral contraceptives regimens did not significantly affect the lipid metabolism. It can be safely used as contraceptive & non-contraceptive purposes. The value of studied parameter for serial longer duration of OCs uses needs to be assessed.

A clinical study of transdermal contraceptive patch in Thai women.

OBJECTIVE: To study cycle control, compliance and safety of a transdermal contraceptive patch in Thai women. MATERIAL AND METHOD: Sixty-nine healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 miccrog/day). All participants aged 18-45 years were invited to participate at the family planning clinic at King Chulalongkorn Memorial Hospital. Adverse effects, perceived advantages, and disadvantages were collected. RESULTS: The participants averaged 22.4 years old, height 158.9 cm, weight 52.5 kg, BMI 20.7. The most common location of patch application was abdomen and the most adverse event was application site reaction (29%) followed by breast tenderness, nausea vomiting, and headache. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. Only 1.1% had breakthrough bleeding. There were no significant changes in body weight and blood pressure. Improvement of their facial acne was reported. There were no pregnancies during the use and the adhesion of contraceptive patch was excellent, partial patch detachment was reported at only 14.4%. No complete patch detachment was found. CONCLUSION: The study found an overall positive impression of new transdermal contraceptive patch. Good compliance and few side effects were demonstrated. The adhesive of the contraceptive patch was excellent.

Norelgestromin/ethinyl estradiol transdermal system.

The transdermal contraceptive patch is an innovative contraceptive technology. The failure rate is quite low and has high continuation rate. The side effects and complications are not different from other hormonal contraceptives. This contraceptive method should be an alternative birth control technique for women.

Consideraciones acerca de la anticoncepción hormonal de emergencia: "La pastilla o píldora del día después" / Emergency contraception is not the \"Abortion pill\" the twotherapies are entirely different and it is important not to confuse them

La anticoncepción hormonal de emergencia es aquella que actúa después de una relación sexual no protegida pero antes del embarazo. Frecuentemente se la denomina como el método de la "píldora del día después" o de "la mañana siguiente". La anticoncepción hormonal de emergencia debe realizarse dentro de las 72 horas que siguen a una relación sexual no protegida, es decir, antes de la fecundación y del inicio del embarazo. Existen varios métodos de anticoncepción hormonal de emergencias efectivos, entre los cuales los más utilizados con el de Yuzpe y el del levonorgestrel exclusivo. Estos implican solamente tomar una mayor dosis de anticonceptivos habituales por un día. Estos son verdaderos anticonceptivos que evitan el embarazo, sea inhibiendo o retrasando la ovulación. No provocan el aborto si la mujer ya está embarazada en el momento de tomar las píldoras.

Avaliação da tolerabilidade, aceitabilidade e controle do ciclo em adolescentes usuárias de anticoncepcional hormonal combinado oral de baixa dose com gestodeno e etinilestradiol / Assessment of the tolerability, acceptability and cycle control in tenager users of oral low dose combined hormonal contraceptive with gestodene and ethinylestradiol

OBJETIVO: Os anticoncepcionais hormonais orais vêm sofrendo progressiva redução de dose desde as suasformulações iniciais, sem, no entanto comprometer sua eficácia e com considerável melhora do seu perfil de segurança. Entre jovens adolescentes, a satisfação com essas novas formulações tem sido maior que a de usuárias de outros métodos. Isso é particularmente conveniente, já que nessa faixa etária ocorre a maioria das gestações não-desejadas. O impacto causado por essas gestações e os riscos associados ao alto percentual de abortos justifica o desenvolvimento e a análise de novas formulações contraceptivas em pacientes adolescentes. Nosso objetivo neste estudo foi avaliar a tolerabilidade, aceitabilidade e controle do ciclo de um contraceptivo hormonal oral de baixa dose contendo gestodeno (75 microgramas) e etinilestradiol (20 microgramas), em mulheres adolescentes. MÉTODOS: Este foi um ensaio clínico aberto, não-comparativo e multicêntrico conduzido em pacientes ambulatoriais. A idade das participantes deste estudo variou de 14 a 20 anos. Estatísticas descritivas foram empregadas para a análise do controle do ciclo e segurança. Alterações de peso, estatura, pressão arterial, freqüência cardíaca, dados laboratoriais, duração do ciclo, e sangramento de privação foram avaliados pelo teste t pareado. RESULTADOS: O presente estudo avaliou um número significativo de ciclos (918 ciclos) para permitir uma análise adequada dos sangramentos de privação e intermenstruais na vigência da medicação proposta. Conforme observamos, o emprego da formação GTD75/EE20 ofereceu um bom controle do ciclo, praticamente não alterando o padrão próprio da usuária, prévio ao uso do contraceptivo. CONCLUSÕES: A formulação contraceptiva GTD75/EE20 traz características muito adequadas à sua indicação em adolescentes que, para aceitação e aderência apropriadas, necessitam de um método seguro, com bom controle de ciclo, eficácia contraceptiva, bom controle do peso corporal e baixa incidência de reações adversas

Effects of a monophasic pill containing 20 microg ethinylestradiol and 150 microg desogestrel on lipid metabolism in Thai women.

OBJECTIVES: To investigate the effects of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel (Mercilon) on lipid metabolism in Thai women. METHOD: The study was carried out at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Twenty women of fertile age were enrolled and treated with the study oral contraceptives for 12 cycles. Lipid parameters were assessed before treatment and periodically during treatment. RESULTS: There was a significant increase in triglyceride, high desity lipoprotein-cholesterol, apolipoproteins AI and AII. No significant changes were found in total cholesterol, low density lipoprotein-cholesterol and apolipoprotein B. CONCLUSION: The effects of the oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel on lipid parameters in Thai women appear to be favorably beneficial.

Effects of a monophasic oral contraceptives containing 30 ug ethinyl estradial and 150 ug desogestrel on lipid metabolism in Sudanese women

This study was conducted to determine the effects of a monophasic oral contraceptive containing 30[Mmicro]g ethinyl estradiol and 150[micro]g desogestrel [Marvelon] on serum concentration of triacylglycerols, total cholesterol, and lipoprotein cholesterol fractions in 50 Sudanese women aged 18-30 years. Six treatment cycles were compared with the cycle prior to the first treatment cycle [pretreatment cycle]. Serum concentration of the studied lipid parameters increased progressively. Increase in serum concentration of triacylglycerols, high density lipoprotein cholesterol [HDL-C] and very low density lipoprotein cholesterol [VLDL-C] was not statistically significant [P>0.05] after the last treatment cycle, when compared with the pretreatment cycle. Increase in serum concentration of total cholesterol and low density lipoprotein cholesterol [LDL-C] was statistically significant [P<0.05]. HDL-C/LDL-C ratio decreased non significantly after the last treatment cycle. Marvelon showed high effectiveness as a contraceptive agent, exhibited better cycle control. Menstrual complaints were minor. Reported side effects tended to subside by the last treatment cycle

Clinical study of a monophasic pill containing 20 microg ethinylestradiol and 150 microg desogestrel in Thai women.

OBJECTIVES: To evaluate the contraceptive reliability and clinical effects of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel (Mercilon) in Thai women. METHOD: The study was carried out at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. One hundred and forty six healthy women of fertile age were enrolled and treated with the study oral contraceptives for 12 cycles. Clinical data of vaginal bleeding, side effects, blood pressure and body weight were assessed periodically. RESULTS: One thousand four hundred and twenty five cycles were evaluated. No conception occurred. The cycles were almost regular. The incidence of irregular bleeding was highest in the first cycle, after the third cycle, the value was below 4 per cent. Side effects were very few. There was no change in blood pressure. A slight decrease in mean body weight was observed. CONCLUSION: The oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel has high contraceptive efficacy, good cycle control and minimal side effects.

Eficácia, tolerabilidade, controle de ciclo e bem-estar em mulheres acima de 35 anos utilizando um contraceptivo de baixa dose contendo gestodeno e etinilestradiol (Harmonet) / Efficacy, tolerability, cycle control and welfare in woman above 35 years using a low dose contraceptive containing gestodene and ethynilestradiol (Harmonet)

Um estudo multicêntrico foi conduzido em 14 centros brasileiros para avaliar a eficácia, tolerabilidade, controle de ciclo e bem-estar em mulheres, não fumantes, acima de 35 anos utilizando um contraceptivo de baixa dose contendo gestodeno e etinilestradiol, durante seis ciclos de tratamento. Participaram do estudo 180 mulheres na faixa etária de 35 a 47 anos, das quais 158 (87,8 por cento) completaram os seis ciclos de tratamento. Nenhuma gravidez ocorreu entre as usuárias do contraceptivo em estudo. Um total de 950 ciclos foi avaliado. Em 92,5 por cento dos ciclos não houve spotting nem sangramento de escape. Ocorreu spotting em 7,2 por cento dos ciclos e sangramento de escape em 0,3 por cento dos ciclos. Com relação ao número de mulheres, 82,2 por cento não apresentaram spotting nem sangramento de escape em nenhum momento do ciclo. Observou-se uma diminuição significativa, indicativa de melhora, com relação ao pré-tratamento, nos escores do questionário de Moos de desconforto menstrual relativos a dor, concentração, mudanças comportamentais, afeto negativo, reações autonômicas, retenção hídrica e controle. Não houve alterações clinicamente significativas de peso, pressão arterial nem resultados laboratoriais. A adesão ao tratamento foi boa, tendo havido esquecimento de tomada de uma ou mais pílulas em apenas 3 por cento do total de ciclos; 12,2 por cento das mulheres não completaram o período de seis ciclos de tratamento, sendo que em 1,1 por cento dos casos a razão para descontinuação foi atribuída a efeitos adversos. Os resultados permitem concluir pela eficácia contraceptiva, bom controle de ciclo, tolerabilidade e bem-estar associados ao uso do contraceptivo de baixa dose contendo gestodeno e etinilestradiol em mulheres acima de 35 anos.

Eficacia y aceptabilidad en mujeres venezolanas de un anticonceptivo oral monofásico que contiene 20 microgramos de etinilestradiol y 150 microgramos de desogestrel / Efficacy and acceptability in Venezuelan females of a oral monophasic contraceptive containing ethynilestradiol 20 micrograms and desogestrel 150 micrograms

Evaluar la eficacia anticonceptiva, control de ciclo, aceptabilidad por parte de la usuaria, cambios en el peso corporal y tensión arterial con el uso de un anticonceptivo oral monofásico que contiene 20 microgramos de etilestradiol y 150 microgramos de desogestrel. Estudio abierto no comparativo multicéntrico donde participaron 122 mujeres proporcionando datos relativos a 600 ciclos. Ocho centros privados localizados en Caracas, Barquisimeto y Mérida. De las 122 mujeres evaluadas durante 600 ciclos, no se presentó embarazo, el control del ciclo tuvo una duración en todos los casos entre 3 a 5 y no huvo cambios estadísticamente significativos con respecto al peso corporal y tensión arterial. Los resultados derivados de este estudio sugieren que la reducción en la dósis de etinilestradiol a 20 microgramos permite todavía una máxima eficacia, buena aceptabilidad y un adecuado control de ciclo

Aspectos morfométricos do endométrio de mulheres na menacme, antes e após o uso de gestodeno e etimilestradiol / Endometrium morphometric aspects of women in menacme, before and after using a gestodene ethynilestriol association

Estudaram-se, através da microscopia eletrônica de cinco mulheres na menacme. Para tanto, foram realizadasbiopsias endometriais no décimo e no vigésimo dia do ciclo menstrual. Estas pacientes foram submetidas à trapêutica contraceptiva hormonal através do uso da associação gestodeno-etinilestradiol, nas doses de 0,075 e 0,03mg respectivamente, durante seis ciclos consecutivos de vinte e um dias, com sete dias de intervalo. No sexto ciclo foram realizadas novas biopsias, também no décimo e vigésimo dias, e, como dentre as demais amostras, antes e depois do uso da associação hormonal. Os resultados permitem concluir que, após a hormonioterapia, a morfologia das células do eptélio luminal e a das células estromais assemelham-se às encotradas na primeira fase do ciclo menstrual normal (sem homônio). Ocorrem também discreta atrofia do eptélio luminal e moderada resposta progestogênica, sem modificações deciduais. O gestodeno antagoniza os efeitos proliferates dos estrogênios sobre fibroblastos e determina o surgimento de edema estromal

Delayed puberty.

Delayed puberty is a frequently encountered problem causing much anxiety to patient and parents alike. Proper understanding of the normal pubertal events and its variation sets off the background to understand disorders leading to delayed puberty. An orderly clinical approach combined with continued observation helps to arrive at a final diagnosis in most of the patients. The treatment modalities available, even if not curative, can achieve the goals of management set off at the end of evaluation of the patient.