Association of oral contraceptive and metformin did not improve insulin resistance in women with polycystic ovary syndrome / A associação de contraceptivo hormonal oral e metformina não melhora a resistência insulínica em mulheres com síndrome dos ovários policísticos.

Summary Objective: Objective: to compare clinical and laboratory parameters in women with polycystic ovary syndrome (PCOS) using metformin or combined oral contraceptive (COC) after 6 months. Methods: retrospective study analyzing records of patients with PCOS using the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society criteria. The groups were: I-COC (21 tablets, pause of 7 days; n=16); II-metformin (850mg 12/12h, n=16); III-COC plus metformin (n=9). Body mass index (BMI), acne (% of improvement), modified Ferriman-Gallway index and menstrual cycle index (MCI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), androstenedione (A) and homeostasis model assessment: insulin resistance (HOMA-IR) index were assessed Results: isolated use of COC compared to metformin was better regarding to acne, Ferriman index, MCI, LH, TT and A levels. On the other hand, metformin was better in the HOMA-IR index (4.44 and 1.67 respectively, p=0.0007). The association COC plus metformin, compared to metformin alone shows the maintenance of improvement of acne, Ferriman index, MCI, and testosterone levels. The HOMA-IR index remained lower in the metformin alone group (4.19 and 1.67, respectively; p=0,046). The comparison between COC plus metformin and COC alone, in turn, shows no difference in the improvement of acne, Ferriman index, MCI, LH, TT and A levels, indicating that the inclusion of metformin did not lead to additional benefits in these parameters. Still, the HOMA-IR index was similar in both groups (4.19 and 4.44 respectively; p=0.75), showing that the use of metformin associated with COC may not improve insulin resistance as much as it does if used alone. Conclusion: our data suggest that the combination of metformin and contraceptive does not improve insulin resistance as observed with metformin alone. .

Resumo Objetivo: comparar parâmetros clínicos e laboratoriais de mulheres com síndrome dos ovários policísticos (SOP) em uso de metformina ou contraceptivo hormonal oral (CHO) após 6 meses. Casuística e métodos: estudo retrospectivo com análise do prontuário de pacientes com SOP (pelos critérios da Androgen Excess and Polycystic Ovary Syndrome Society [AE-PCOS Society]), divididos em 3 grupos: (I) CHO (21 comprimidos e pausa de 7 dias; n=16), (II) metformina (850 mg a cada 12 horas; n=16) e (III) CHO associado com metformina (n=9). Foram avaliados: índice de massa corpórea (IMC), acne (% de melhora), índice de Ferriman-Gallway modificado, índice de ciclos menstruais (ICM), LH, FSH, testosterona total (TT), androstenediona (A) e resistência a insulina (HOMA-IR, do inglês homeostatic model assessment: insulin resistance). Resultados: o uso isolado de CHO comparado ao de metformina foi melhor em relação a acne, índice de Ferriman, ICM, níveis de LH, TT e A. Por outro lado, a metformina foi melhor para HOMA-IR (4,44 e 1,67; p=0,0007). O uso do CHO e metformina, em comparação com o de metformina isolada, manteve a melhora da acne, do índice de Ferriman, do ICM e dos níveis da TT. O índice de HOMA-IR manteve-se menor no grupo metformina isolada (4,19 e 1,67; p=0,046). Por sua vez, a melhora na acne, Ferriman, ICM, LH, TT e A são semelhantes nos grupos CHO associado com metformina e CHO isolado, indicando que a adição de metformina não trouxe benefícios nesses parâmetros. Ainda, o HOMA-IR foi semelhante nos dois grupos (4,19 e 4,44; p=0,75), mostrando que o uso de metformina em associação com o contraceptivo pode não melhorar a resistência insulínica como ocorre no uso isolado. Conclusão: os dados sugerem que a associação de metformina e contraceptivo não melhora a resistência insulínica como ocorre no uso da metformina isolada. .

Evaluation of sensitivity, motor and pain thresholds across the menstrual cycle through medium-frequency transcutaneous electrical nerve stimulation

OBJECTIVES: The aim of this study was to identify variations in nervous thresholds in different phases of the menstrual cycle in eumenorrheic women and users of oral contraceptives. METHOD: An observational study was performed including 56 volunteers, consisting of 30 eumenorrheic women who were non-users of oral contraceptives and 26 users of oral contraceptives. An electrical stimulator was employed to assess their nervous thresholds, with pulses applied at a fixed frequency of 2,500 Hz, modulated at 50 Hz, with phase variances of 20 μs, 50 μs and 100 μs. Sensitivity, motor and pain thresholds were evaluated during five menstrual cycle phases: phase 1 - menstrual, phase 2 - follicular, phase 3 - ovulatory, phase 4 - luteal and phase 5 - premenstrual. RESULTS: The results indicated low sensitivity thresholds of 100 μs for non-users of oral contraceptives and 50 μs for oral contraceptive users in phase 5. Low motor thresholds of 20 μs, 50 μs and 100 μs were observed for non-users of oral contraceptives in phase 5, while that of oral contraceptive users was 100 μs. Finally, a low pain threshold of 100 μs was observed in phase 5, but only in the oral contraceptive group. CONCLUSION: Nervous thresholds vary systematically across the phases of the menstrual cycle, with or without the use of oral contraceptives. These variations should be taken into account during research performed in women. .

Role of metformin in polycystic ovarian syndrome

To assess the role of Metformin in Polycystic ovarian syndrome [PCOS]. This interventional, quasi-experimental study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from October 2004 to October 2006. A total of 35 patients with PCOS were included fulfilling Rotterdam Criteria. Metformin was given in a dose of 850 mg twice a day. Patients' reassessment was done clinically on a three monthly basis while laboratory investigations and Transvaginal scan was done after two years. Data was analysed using SPSS v. 16. The mean age of the sample was 27 +/- 5.2 years. Out of 35, 29[82.8%] had primary infertility while 6[17.2%] had secondary and only 7[20%] of those conceived. Menstrual irregularities were present in30[85.7%] patients, 27[55.5%] with oligomenorrhea, 2[5.7%] with amenorrhea and 1[2.86%] with polymenorrhea. Out of these 15, 2 and 1 showed improvement, respectively. Regarding hyperandrogenism,22[62.8%] patients were with hirsutism, 3[9.4%] had acne and 10[28.5%] had hair loss. Out of these 0, 2and 3 improved, respectively. Transvaginal scan showed polycystic ovaries in all patients at baseline while the cysts dissolved in 15[42.8%] patients. Biochemical investigations like Leutinizing Hormone: Follicle Stimulating Hormone[LH:FSH], Serum Testosterone, Serum Prolactin, Random Blood Sugar[RBS] and Serum Insulin was raised in 32[91.4%], 24[68.5%], 9[25.7%], 3[8.5%] and 10[28.5%] patients respectively and 17[53.1%], 13[54.2%], 4[44.4%], 1[33.3%] and 4[40%] patients improved respectively. Metformin is an effective drug to improve the menstrual irregularities, LH:FSH and serum testosterone but it does not show improvement in clinical signs and symptoms of hyperandrogensim

One-year assessment of women receiving sub-dermal contraceptive implant at Siriraj Family Planning Clinic.

BACKGROUND: The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method. MATERIAL AND METHOD: This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed. RESULTS: Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use. CONCLUSION: Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.

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.

The salivary ferning test and ovulation in clomiphene citrate-stimulated cycles.

OBJECTIVE: To determine the day of ovulation by the salivary ferning test in clomiphene citrate-treated women. DESIGN: A descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. SUBJECT: Seventy-five infertile women with regular menstrual cycles. MATERIAL AND METHOD: Infertile women were given 100 mg of clomiphene citrate for five days and collected their saliva samples daily until seven days after ovulation. Transvaginal ultrasound was performed daily to detect ovulation. The salivary ferning formation was examined by a normal light microscope and graded from 1-3, according to its extent and intensity. MAIN OUTCOME MEASURE: The salivary ferning score, the peak salivary ferning day, and the day of ovulation detected by ultrasound. RESULTS: The patients' age and cycle length (mean +/- SD) were 32.9 +/- 3.7 years and 28.4 +/- 1.3 days. The peak salivary ferning day corresponded with the ultrasound ovulation day in only 7.1%. There were two peaks of median salivary ferning scores; one was two days prior ovulation and the other was five days post ovulation. There was no correlation between the peak salivary ferning day and day of ovulation detected by ultrasound (r = 0.102, p > 0.05). CONCLUSION: In clomiphene citrate-stimulated cycles, the saliva ferning test does not seem to associate with ovulation.

Effects of biphasic oral contraceptives containing desogestrel (Oilezz) on cycle control facial acne and seborrhea in healthy Thai women.

OBJECTIVE: To demonstrate the effects of a new biphasic oral contraceptive (Oilezz) on cycle control as well as mild to moderate acne and facial seborrhea of healthy fertile Thai women. MATERIAL AND METHOD: The trial is a prospective, open, non-comparative, single center study. Fifty healthy, fertile Thai women with mild to moderate facial acne were recruited to study a specific drug (Oilezz) for 6 months. RESULTS: At the beginning, 66% of the subjects had mild acne and 34% had moderate acne. Significant improvements in facial seborrhea grades (as indicated by Sebutape assessments) were found after the first cycle. These improvements increased steadily and were much larger after the sixth cycle. There were no statistically significant changes in body weight or blood pressure during the study. No serious adverse events were reported. There were no mood changes, migraine, rash, abdominal discomfort, malaise, nausea and decrease in libido during the study period The premenstrual symptoms at initiation were 21 cases (42%). The symptoms were 4 (8%) with headache, 8 (16%) with breast tenderness, 5 (10%) with dysmenorrhea and one (2%) with bleeding irregularity. These symptoms were improved in the third and the sixth cycles. The percentage of women with spotting or bleeding increased after first cycle, compared with baseline and gradually decreased during subsequent cycles. After the sixth cycle of treatment, all subjects had improvement of acne. 80% of cases recovered from acne and there were only 20% had mild acne. CONCLUSION: Facial seborrhea and acne improved significantly with Oilezz. It is good to control cycle without change in body weight and blood pressure. Therefore, Oilezz can be used for treatment of seborrhea and acne and as a contraceptive.

Effects of Jadelle used in Thai women aged between 20 and 45 years in King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study the menstrual patterns and side effects of Jadelle use in Thai women aged between 20 and 45 years. STUDY DESIGN: Prospective descriptive study. SETTING: Family Planning Clinic, Department of Obstetrics and Gynecology, King Chulalongkorn Memorial hospital. MATERIAL AND METHOD: A prospective clinical trial study was conducted at the Family Planning Unit, King Chulalongkorn Memorial Hospital in June 2005. The study duration was 6 months. The data was obtained from each patient S medical record. The descriptive statistics was frequency, percentage, mean, SD and 95% Confidence Interval (CI). The statistical analyses were performed by using the paired t test for comparison of means before and after 6 months of Jadelle used. RESULTS: A total of 59 women were recruited in a 6-month clinical study. Their mean age was 29.07years. Most acceptors had completed secondary school. No accidental pregnancy occurred throughout the 6 months of use in the present study. The most common menstrual pattern was amenorrhea followed by irregular bleeding. The major side effect was irregular bleeding. There was no significant change in body weight, body mass index, and systolic-diastolic blood pressure during the 6 months follow up period. The common non menstrual adverse effects were headache, acne, alopecia. DISCUSSION: The most common menstrual patterns found in the present study were amenorrhea and irregular bleeding followed by a regular cycle. The common nonmenstrual adverse effects were headache, acne, and alopecia. There were no pregnancies in the 6-month follow-up period. Jadelle was an effective implant contraceptive method with an acceptable bleeding pattern. Over all acceptability was good. This should become another choice of contraception for Thai women.

The oral contraceptive pill effectively permits cycle batching for an intermittent in vitro fertilization programme in Trinidad and Tobago / Las Píldoras Anticonceptivas Orales Permiten la Agrupación Eficaz de los Ciclos para un Programa Intermitente de FIV en Trinidad y Tobago

Assisted reproductive technology (ART) in small island states like Trinidad and Tobago is usually provided in batches so as to minimize the cost of providing the service. As a result, patients 'cycles have to be synchronized in order to coincide with the arrival of a visiting embryologist. This is a retrospective study which evaluates the experience of pre-treatment with an oral contraceptive pill (OCP) as a means of batching cycles for an intermittent ART programme. Seventy-four in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in which OCP usage was employed (Group A), were compared with 121 cycles which did not require pharmaceutical manipulation (Group B). In both groups more than 50 of women were older than 36-years. Two cycles were cancelled in Group A and seven in Group B, because of poor ovarian response. Although the pregnancy rate per treatment cycle was higher in Group A than in Group B (26.3 vs 17.3), this difference was not significant. More spontaneous miscarriages occurred in the non-OCP women and ovarian cyst formation was more common in these women. The authors experience indicates that the OCP is a simple, cheap and efficient means of batching patients for an intermittent ART programme and can be utilized in other small ART centres

La tecnología de reproducción asistida (TRA) en los pequeños estados insulares como Trinidad y Tobago, usualmente se ofrece por tandas a fin de minimizar los costos del servicio brindado. En consecuencia, los ciclos de las pacientes tienen que ser sincronizados de modo que coincidan con la visita del embriólogo. Éste es un estudio retrospectivo que evalúa la experiencia del pretratamiento con píldoras anticonceptivas orales (PAO) como medio de agrupar los ciclos con el propósito de organizar un programa intermitente de TRA. Setenta y cuatro ciclos de fertilización in vitro (FIV) e inyección intracitoplasmática de esperma (ICSI) en los que se recurrió al uso de PAO (Grupo A), fueron comparados con 121 ciclos que no requirieron manipulación farmacéutica (Grupo B). En ambos grupos, > 50% de las mujeres tenían más de 36 años de edad. Dos ciclos fueron cancelados en el grupo A y siete en el grupo B, debido a una respuesta ovárica pobre. Aunque la tasa de embarazo por ciclo de tratamiento fue más alta en el grupo A que en el grupo B (26.3% vs. 17.3%), esta diferencia no fue significativa. El número de abortos espontáneos fue mayor y la formación de quistes ováricos más común, en las mujeres que tomaron PAO. La experiencia de los autores indica que la PAO es un medio simple, económico y eficaz de agrupar a los pacientes en un programa intermitente de TRA, y puede utilizarse en otros centros pequeños de TRA.

Salt preference across different phases of menstrual cycle.

It is well established that women experience food craving for particular foods and gain weight in relation to phases of menstrual cycle. In this study, the preference for different concentrations of salt sprayed on bland popcorn was assessed in 55 healthy women (age 18 to 22 yrs). Salt solutions of 0, 1, 2, 3 and +3 molar strength were used. Samples of sprayed popcorn were consumed in random order and preference marked on a Likert scale. It was observed that women preferred unsalted popcorn in the menstrual phase more than in the luteal phase. The preference for salted popcorn was most during the luteal phase and was proportionate to the strength of the salt solution used. Statistical analysis revealed significant differences in the preference rating between the menstrual phase and the other two phases. There was no significant difference in preference between the luteal and follicular phases.

A randomized trial on the impact of starting day on ovarian follicular activity in very low dose oral contraceptive pills users.

In a randomized trial, the impact of starting day (the first and the seventh day of the period) on ovarian follicular activity was assessed during administration of a very low dose of oral contraceptive pills (20 microgram (mcg) ethinyl estradiol (EE) and 75 mcg gestodene (GS) [Meliane, Schering, Germany]). One hundred and sixty healthy women aged: 23-44 years, who had a regular cycle, and who were not using any type of oral contraceptive (OCs) steroid were studied at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. In the trial, each subject received a package of Meliane. They were blockwise randomized, 1:1 ratio; in the first group, subjects began their pills on the first day of their period (n = 80) and the other group, the seventh day of their period (n = 80). During the treatment cycle, ovarian activity was evaluated by transvaginal sonography (TVS) to determine the follicular-like structure (FLS). Ovulation was defined as the dominant FLS detected by TVS and followed-up every other day until its collapse. It occurred in 0 of 77 cases who started on the first day of their period and occurred in 8 of 78 cases of the group which started on the seventh day of their period. The difference was of statistical significance (p = 0.006). The result of this clinical trial is beneficial information for users of OCs containing 20 mcg EE who delay start of the OCs package.

Impacto do alcoolismo em mulheres: repercussoes clinicas / Impact of alcoholism in women: clinical repercussions

O alcoolismo entre as mulheres supera as particularidades observadas no ambito meramente psiquiatrico. Alem das caracteristicas ja conhecidas nesse campo, e necessario reconhecer as demais areas de impacto do consumo de alcool pelas mulheres...

Acetato de medroxiprogesterona de depósito como anticoncepcional injetável em adolescentes / Depot medroxyprogesterone acetate as an injectable contracptive for adolescents

Quarenta adolescentes iniciaram o uso do contraceptivo injetável trimestral acetato de medroxiprogesterona de depósito (DMPA), tendo sido acompanhadas por uma média de 14,2 meses. Somente 10 por cento eram nulíparas e 70 por cento estavam amamentando ao início do medicamento. As queixas mais freqüentes foram cefaléia (16,6 por cento) e cólica (15,2 por cento). Os padröes menstruais predominantes foram o spotting e a oligomenorréia. Houve uma ligeira queda nos níveis da pressäo arterial sistólica durante o acompamhamento, mais houve uma ligeira queda nos níveis da pressäo arterial diastólica, no limite da significância. Um exame comparativo após a terceira dose do medicamento näo mostrou alteraçöes significativas da glicemia de jejum, mas foi abservada uma tendência ao aumento da taxa de hemoglobina com uso do DMPA. O ganho de peso (média de 3,9 kg em 12 meses) e a irregularidade menstrual (70 por cento em qualquer retorno) foram os principais motivos para a desistência do método. Vinte e sete pacientes foram acompanhadas por 12 meses e a taxa de continuidade nessa época foi de 81,48 por cento. Conclui-se que o acetato de medroxiprogesterona de depósito se mostrou um contraceptivo satisfatório para as adolescentes

Determinantes da Síndrome pré-menstrual: Análise de aspectos clínicos e epidemiológicos

Resumo: A síndrome Pré-Menstrual é condiçäo mal definida e mal compreendida, näo havendo consenso na maioria dos seus aspectos. Com o objetivo de discutir seus determinantes, realizou-se estudo descritivo de corte transversal, sobre presença e intensidade de sintomas no período pré-menstrual em 254 mulheres. Foram identificados quatro grupos: as sem sintomas, que correspondem a 13,8 por cento; as com forma leve, 22,4 por cento; as com forma moderada, totalizando 20,5 por cento e as identificadas como forma grave, que foram 43,8 por cento. Utilizando-se análise por regressäo logística , odds ratio e testes de confiança constatou-se associaçäo da forma grave com viver com companheiro, ter sido submetida à ligadura tubária ou näo trabalhar fora. Quanto a idade, cor, qualidade do relacionamento conjugal, idade à primeira gestaçäo e à menarca, uso de anticoncepcionais hormonais, atividade sexual e suas disfunçöes, gestaçöes, abordamentos, uso de cafeína, tabagismo, escolaridade e renda näo houve diferenças significativas. A forma grave foi mais prevalente nas mulheres que têm dismenorréia ou ciclo irregular. Os antecedentes de doenças psiquiátricas, hipertensäo na gestaçäo, asma, alergias, calclose renal, convulsöes e artrite näo mostraram diferenças. Entre as com forma grave o sintoma mais relatado foi irritabilidade 88 por cento, seguido por cansaço em 70 por cento, depressäo e cefaléia 61,8 por cento, sendo que 94 por cento apresentavam mais de um sintoma e 76,4 por cento de sintomas físicos e psíquicos. Poucas procuravam tratamento sendo que, segundo as que o fizeram, os profissionais disseram que näo era nada. Concluiu-se que a SPM afetou quase a totalidade das mulheres , metade delas intensamente, geralmente por poucos dias, geralmente por poucos dias, estando associada tanto a condiçöes biológicas quanto a psicossociais.

Avaliação da tolerabilidade e do controle de ciclo de dois contraceptivos orais de baixa dose: estudo comparativo aberto / Assessment of the tolerability and cycle control of two low-dose oral contraceptives: an open-label study

Realizou-se um estudo aberto comparativo em nove centros brasileiros para avaliar a tolerabilidade e o controle de ciclo obtido com o uso de dois contraceptivos orais de baixa dose contendo 20 mg etinilestradiol/75 mg gestodeno e 20 mg etinilestradiol/150 mg desogestrel, durante seis ciclos de tratamento. Foram selecionadas 167 mulheres saudáveis com vida sexual ativa (77 no grupo do gestodeno e 90 no grupo do desogestrel), das quais 138 completaram os seis ciclos de tratamento. Em um subgrupo de novas usuárias realizou-se também perfil lipídico e hemostático. Foram avaliados 867 diclos no total. Ocorreu sangramento irregular em 4,6 por cento dos ciclos com gestodeno e em 8,1 por cento com desogestrel. A tolerabilidade a ambas preparações foi boa, mas houve significativamente mais náusea no grupo do desogestrel. O controle de ciclo foi bom com os dois contraceptivos, sendo que houve freqüência significativamente menor de sangramento irregular no grupo do gestodeno quando se leva em conta que todos os ciclos foram considerados. Não houve alterações clinicamente significativas no perfil hemostático. O perfil lipídico mostrou tendência a tornar-se mais favorável após seis ciclos de tratamento com as duas preparações. Não ocorreu alteração no peso médio das mulheres no grupo do gestodeno; no grupo do desogestrel houve aumento significativo no peso médio de aproximadamente 1 Kg após seis meses de tratamento. A adesão ao tratamento foi boa com as duas preparações. Os resultados deste estudo mostram que preparações contendo baixa dose de gestodeno ou desogestrel associados a 20 mg de etinilestradiol são contraceptivos bem tolerados que permitem bom controle de ciclo, sem efeitos colaterais significantes.

Expressäo de prolactina, c-fos e TGFßno endométrio humano: influência do ciclo menstrual e efeitos de acetato de medroxiprogesterona / Expression of prolactin, c-fos and TGFß in human endometrium: influence of the mestrual cycle and medroxyprogesterone acetate effects

O mecanismo de açao dos esteróides sexuais sobre a proliferaçao e deferenciaçao do endométrio envolve a paraticipaçao de fatores de crescimento e protooncogenes, cuja regulaçao é pouco conhecida. O objetivo deste trabalho foi investigar a influência do ciclo menstrual e os efeitos do acetado de medroxiprogesterona (MPA) sobre a expressao de prolactina (PRL), do protooncogene c-fos e do fator de crescimento TGFBeta no endométrio humano in vivo. Quarenta e seis mulheres com ciclos regulares receberam, de forma randomizada, placebo ou MPA (10mg/dia, 10 dias). Em seguida foram submetidas a biópsia do endométrio e as amostras foram classificadas em 3 grupos de acordo com a fase do ciclo/tratamento: Proliferativo/Placebo (grupo 1, N=11), Secretor/Placebo (grupo 2, N=18) e o Secretor/MPA (grupo 3, N=8). Parte do material foi fixada em formol e incluída em parafina, sendo posteriormente submetida a coloraçao por imuno-histoquímica. O restante foi congelado a-70 Graus Celsius para posterior análise do RNA mensageiro (mRNA) pela técnica de RT-PCR. Encoutrou-se PRL imunorreativa no epitélio glandular de 9,1 por cento das amostras do grupo 1, em 55,6 por cento das amostras do grupo 2 e em 100 por cento das amostras do grupo 3 (p<0,05; teste de Fisher). No estroma endometrial, observou-se imunocoloraçao para PRL em 9,1 por cento, 66,7 por cento e 87,5 por cento das biópsias dos grupos 1,2 e 3, respectivamente (p<0,01). Os níveis médio de mRNA da PRL foram maiores na fase secretora (grupo 2) e significativamente maiores no grupo 3 em relaçao ao grupo 1 (p<0,05). Observou-se imunocoloraçao para c-fos (predominando no núcleo das células estromais) em 54,5 por cento das biópsias do grupo 1, em 7,1 por cento das do grupo 2 e em nenhuma do grupo 3 (p<0,05, grupo 1 vs 2 e 3). Os níveis de mRNA do c-fos foram substancialmente menores nos grupos 2 e 3 comparados ao grupo 1 (p<0,05) e apresentaram correlaçao direta com os níveis séricos de estradiol (r=0,56; p<0,02). Nao houve diferença entre os grupos quanto à expressao de TGFBeta 1. Entretanto, a freqüência de amostras com imunocolaraçao positiva para TGFBeta 3 foram sucessivamente maiores nos grupos 2 e 3 em comparaçao com o grupo 1. Os dados demonstram aumento da expressao de PRL e TGFBeta 3 e inibiçao da expressao de c-fos no endométrio durante a fase secretora do ciclo menstrual, bem como no endométrio estimulado por MPA. A inibiçao de c-fos e o aumento na expressao de TGFBeta 3 poderiam...

Eficácia, tolerabilidad e controle de ciclo de um contraceptivo oral sem estrogênio contendo 30 mcg de levonorgestrel (minipílula) / Efficacy, tolerability and cycle control of a progestin-only contraceptive containing levonorgestrel 30 mcg (mini-pill)

Um estudo aberto e multicêntrico foi conduzido em 10 centros brasileiros para avaliar a eficácia, tolerabilidade e controle de ciclo de um contraceptivo sem estrogênio contendo 30 mcg de levonorgestrel (minipílula) durante seis meses de tratamento no período pós-parto. Participaram do estudo 261 voluntárias saudáveis, sexualmente ativas, que se encontravam no período pós-parto, estando ou näo amamentando. Nenhuma gravidez ocorreu entre as usuárias do contraceptivo em estudo. No primeiro mês de tratamento 71, 6 por cento das mulheres encontravem-se em amenorréia e no sexto mês de tratamento essa porcentagem passou para 85,1 por cento (p<0,05). Sangramentos ocasionais e spotting no primeiro mês de tratamento foram relatados, respectivamente, por 2,4 e 11,6 por cento das mulheres e, no sexto mês de tratamento essas porcentagens caíram, respectivamente, para 0 (p=0,250) e 3,5 por cento (p<0,05). Sangramento com padräo regular, que foi interpretado como menstruaçäo ,foi observado em 19,6 por cento das mulheres no primeiro mês de tratameto e 11,8 por cento no sexto mês (p=0,048). Observou-se no sexto mês uma diminuiçäo significativa, com relaçäo ao primeiro mês, da incidência e intensidade de sinais e sintomas comumente observados com o uso de contraceptivos hormonais. Näo houve diferença estatisticamente significativa entre o início e o término do tratamento com relaçäo à quantidade de secreçäo láctea, avaliada do ponto de vista subjetivo das mulheres. A adesäo ao tratamento foi boa, tendo havido esquecimento de tomada de uma ou mais pílulas por 12,6 por cento das mulheres. Apenas 8,8 das mulheres näo completaram os seis meses de tratamento, sendo que em 1,5 por cento do total de mulheres a razäo para descontinuaçäo foi atribuída a efeitos adversos. Os resultados permitem concluir pela eficácia contraceptiva, tolerabilidade e baixa incidência de sangramentos irregulares do contraceptivo tipo minipílula contendo 30 mcg de levonorgestrel

Study of the action of tamoxifen on the mammary gland epithelium of premenopausal patients by lysosome quantification

Tamoxifen is an antiestrogen drug widely utilized for the adjuvant hormonal treatment of breast carcinoma. Its use in the primary prophylaxis of this disease is currently being proposed. Although the drug has few side effects, its precise action on breast tissue that has not undergone neoplastic transformation has not been fully elucidated. This prospective, randomized study assessed the estrogen activity of tamoxifen on the mammary gland epithelium of premenopausal patients using a quantitative analysis of mammary epithelium lysosomes identified by the cytochemical technique of GOMORI for acid phosphatase and by light microscopy. Tamoxifen significantly increased the number of lysosomes only during the secretory phase of the menstrual cycle. We concluded that the early effect of the drug on normal mammary tissue is synergistic with the effect of estrogen during the premenopausal period.

La melatonina en el sistema inmunoneuroendocrino / Melatonin in the immuno-neuro-endocrine system

El conocimiento actual de las relaciones neuroendocrinas e inmunológicas confiere un rol importante a la melatonina (MT) en la regulación de los ritmos circadianos de los mamíferos. La función de la glándulapinela en todas las especies es traducir información del ciclo luz/oscuridad a los ritmos fisiológicos del organismo. La MT es producida casi exclusivamente en la oscuridad. En los humanos la secreción ocurre en correspondencia a la edad, disminuyendo en la vejez; guarda relación inversa con la temperatura del cuerpo; evidencia un efecto anti-estrés, posiblemente a través del sistema opioide; favorece la respuesta inmunológica y protege frente al daño tisular que provocan los radicales libres, por su fuerte acción antioxidante. La MT ha sido usada con éxito en la inducción del sueño en personas que ven perturbado su ritmo habitual de sueño por trabajos nocturnos, el síndrome de jet-lag u otras causas. No se ha logrado beneficio en el tratamiento de trastornos mayores del sueño, ni en la depresión ni en otros trastornos psiquiátricos. La presencia de receptores para la MT en múltiples órganos y sistemas estimula actualmente la investigación clínica sobre estas funciones posibles de la melatonina

Lysine clonixinate in the treatment of primary dysmenorrhea

The efficacy tolerance of Lysine Clonixinate (LC), a NSAID with prostaglandin synthesis inhibiting mechanism was studied in 24 patients with primary dysmenorrhea according to a double-blind randomized crossover Placebo (P) controlled design with patients serving as their own controls. Treatment consisted in administering 1 tablet of LC or P q6h as from onset of menstrual pain during 5 days and 6 menstrual cycles. Patients were controlled monthly as from the 5th day of the cycle rating changes in pain intensity according to a 4-point scale, presence of pain during pre-, post-and menstrual periods: possible intracycle changes, amount of bleeding, tolerance and related total and general signs and symptons. Intensity of baseline menstrual pain amounted to 2.9. Menstrual, intramenstrual and postmenstrual pains were observed in 19 out of 24,24/24 and only 2 out of the patients, respectively. Concomitant symptons consisted in headache (12), mastalgia (14) and disconfort (12). Results were obtained by averaging the data from the 3 tratment periods with each drug. Menstrual pain was reduced from 2.9 + 0.7 to 1.9 + 0.7 with P administration and to 0.66 + 0.4 with the administration of LC, a highly significant difference between tratments (p<0.0001). Premenstrual pain was reduced nonsignificantly from 0.79 per cent to 0.58 per cent with P administration and significantly to 0.29 per cent with administration of LC (p<0.001). Intramenstrual pain affection all patients at baseline was reduced significantly by 8 per cent with P and also significantly by 50 per cent with LC p<0.001). No differences were encontered in encomitant symptoms during P treatment periods while the incidence was significantly reduced with LC (p<0.0001). No changes in cycle duration or amount of bleeding were observed between treatments. No adverse events were reported.