RESUMEN
Objetivo: Analisar o uso dos contraceptivos hormonais em mulheres com asma e a escolha desses métodos contraceptivos para essa população, com avaliação de eventuais repercussões sobre novos episódios de asma e sibilos. Métodos: Foram selecionados estudos longitudinais, ensaios clínicos, revisões sistemáticas e metanálises. As plataformas consultadas foram PubMed, Embase, Cochrane e SciELO, com a utilização dos descritores: "contracepção", "contracepção hormonal", "sistema intrauterino liberador de levonorgestrel" e "asma". Resultados: Dois grandes estudos demonstraram que o uso de contraceptivos hormonais esteve associado à redução do risco de novos episódios de asma. Uma revisão sistemática concluiu que os resultados para o uso de contraceptivos hormonais para mulheres com asma foram mistos, com aumento ou redução dos seguintes riscos: novo episódio de asma e aumento da frequência das crises e dos sibilos. O uso da contracepção hormonal em pacientes obesas portadoras de asma é controverso. Conclusão: Os resultados para o uso de contraceptivos hormonais em mulheres com asma são inconsistentes, com relatos de aumento ou de redução do risco de novos episódios. O uso do método contraceptivo deve ser discutido individualmente, levando-se em consideração outros fatores de risco associados e o desejo da mulher. A paciente deverá ser orientada se houver piora dos sintomas clínicos de asma na vigência do uso de qualquer método contraceptivo hormonal.
Objective: To analyze the use of hormonal contraceptives in women with asthma and the choice of this contraceptive method for this population, evaluating possible repercussions on new episodes of asthma and wheezing. Methods: Longitudinal studies, clinical trials, systematic reviews and meta-analyses were selected. Platforms consulted: PubMed, Embase, Cochrane, SciELO, using the descriptors: "contraception", "hormonal contraception", "levonorgestrel-releasing intrauterine system" and "asthma". Results: Two large studies demonstrated that the use of hormonal contraceptives was associated with a reduced risk of new episodes of asthma. A systematic review concluded that the results for the use of hormonal contraceptives for women with asthma were mixed, with increased or decrease in the following risks: new asthma episodes, increased frequency and wheezing. The use of hormonal contraception in obese patients with asthma is controversial. Conclusion: The results for the use of hormonal contraceptives in women with asthma are inconsistent, with reports of increased or reduced risk of new episodes. The use of the contraceptive method should be discussed individually, taking into account other associated risk factors and the woman's desire. The patient will be advised if there is a worsening of the clinical symptoms of asthma while using any hormonal contraceptive method.
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Asma/complicaciones , Agentes Anticonceptivos Hormonales/efectos adversos , Agentes Anticonceptivos Hormonales/uso terapéutico , Progesterona/efectos adversos , Signos y Síntomas Respiratorios , Dolor en el Pecho/diagnóstico , Menarquia , Ruidos Respiratorios/diagnóstico , Estudios Transversales , Estudios de Cohortes , Estudios Longitudinales , Tos/diagnóstico , Disnea/diagnóstico , Estrógenos , Revisión Sistemática , Pulmón/fisiopatologíaRESUMEN
Resumen ANTECEDENTES: el sangrado uterino anormal por miomatosis intramural de pequeños elementos es una indicación frecuente de histerectomía; el tratamiento hormonal puede disminuir la necesidad de esta cirugía. OBJETIVO: evaluar si con el sistema liberador de levonorgestrel disminuye el sangrado uterino anormal por miomatosis intramural de pequeños elementos. MATERIALES Y MÉTODOS: ensayo clínico fase II de un solo brazo al que se incluyeron mujeres de 35 a 45 años de edad, con diagnóstico de sangrado uterino anormal por miomatosis intramural de pequeños elementos, con útero menor a 12 cm (eje longitudinal por ultrasonido) y biopsia de endometrio sin enfermedad maligna; a todas se les colocó el sistema liberador de levonorgestrel. Se evaluó: el sangrado con la escala PBACs (Pictorial Blood Assessment Chart score), el dolor pélvico con escala de EVA, la recuperación hematológica (hemoglobina sérica), volumen uterino (mm3) y recuperación de la actividad física y sexual antes de la colocación del sistema liberador de levonorgestrel y a los 3, 6 y 9 meses posteriores. RESULTADOS: se estudiaron 20 pacientes, de éstas 3 con histerectomía antes de cumplir los tres meses de seguimiento. A los tres meses 76.4% (IC 95%: 55.9-97) redujeron el sangrado en más de 50% del basal, a los seis meses todas habían reducido más de 50% el sangrado y a los nueve meses, nueve eran amenorreicas, el resto con reducción promedio de 90%. El dolor se redujo y permitió recuperar la actividad física y sexual en 90% de los casos. Las concentraciones de hemoglobina se incrementaron, en promedio, 0.8 g/dL, y no hubo reducción clínicamente significativa del tamaño uterino. CONCLUSIONES: el sistema liberador de levonorgestrel disminuyó de manera muy significativa el sangrado uterino anormal por miomatosis intramural de pequeños elementos a partir de los tres meses de tratamiento.
Abstract BACKGROUND: abnormal uterine bleeding due to small intramural leiomyomas is a frequent indication of hysterectomy; hormone treatment may decrease the need for this surgery. OBJECTIVE: to evaluate if using the levonorgestreal-releasing system decreases abnormal uterine bleeding caused by small intramural leiomyomas. MATERIALS AND METHODS: a phase II single arm clinical trial that included women from 35 to 45 years with a diagnosis of abnormal uterine bleeding caused by small intramural leiomyomas in less than 12 cm uteri (longitudinal axis on ultrasound) and endometrial biopsy with no malignant disease; all the women had the levonorgestrel-releasing system placed. We evaluated: bleeding with the PBAC scale (Pictorial Blood Assessment Chart score), pelvic pain with the EVA scale, hematological recovery (serum hemoglobin), uterine volume (mm3) and recovery of physical and sexual activity before placement of the levonorgestrel-releasing system 3, 6 and 9 months later. RESULTS: 20 patients were studied, 3 of these had a hysterectomy before the three month follow up period. After three months 76.4% % (IC 95%: 55.9-97) decreased bleeding more than 50% compared to baseline, after six months, all had decreased bleeding more than 50% and at nine months, nine had amenorrhea and the rest had an average reduction of 90%. Pain decreased and allowed them to recover physical and sexual activity in 90% of cases. Concentrations of hemoglobin increased an average of 0.8 g/dL and there was no clinically significant reduction of the uterine size. CONCLUSIONS: the levonorgestrel-releasing system significantly decreased abnormal uterine bleeding caused by small intramural leiomyomas after three months of treatment.
RESUMEN
A hiperplasia endometrial caracteriza-se por proliferação anormal de glândulas e estroma, compredominância do componente glandular, que determina graus variados de desarranjo arquitetural.O risco da evolução de hiperplasia para carcinoma está relacionado à presença e à intensidade da atipiacelular. O diagnóstico é mais preciso por histeroscopia com biópsia. Para o tratamento de casoscom atipias, a histerectomia tem sido geralmente recomendada, exceto quando a paciente tem fortedesejo de engravidar ou alto risco cirúrgico. Apresenta-se um caso de hiperplasia endometrialcomplexa com atipias, tratada com sucesso por meio de dispositivo intrauterino com levonorgestrele ocorrência de gravidez a posteriori.
Endometrial hyperplasia is characterized by an abnormal proliferation of glands and stroma, with a predominance of the glandular component, which causes varying degrees of architectural disarrangement. The risk of progression of hyperplasia to cancer is correlated with the presence and intensity of cytological atypia. The diagnosis is more accurate when hysteroscopy with biopsy is performed. For the treatment of cases with atypia, hysterectomy has been generally recommended, except when women have a strong desire for pregnancy or present surgical risk factors. We discuss a case of complex endometrial hyperplasia with atypia successfully treated with levonorgestrel-releasing intrauterine system, with subsequent occurrence of pregnancy.
RESUMEN
El uso continuo de anticonceptivos hormonales activos mediante la inserción del sistema intrauterino liberador de progestágenos (Levonorgestrel) ha sido de gran utilidad, pues además de la deseada acción anticonceptiva se le añade un efecto positivo de utilidad para el manejo de algunas afecciones ginecológicas, como son la endometriosis, fibromatosis uterina y ciertas disfunciones menstruales, a los que se han ido agregando recientemente nuevas indicaciones. OBJETIVO: Evaluar la utilidad del SIU liberador de Levonorgestrel (Mirena) en el manejo de las metrorragias y otras afecciones ginecológicas. MÉTODOS: Se realizó un estudio prospectivo, longitudinal, descriptivo que incluyó a 19 pacientes a las que se les insertó Mirena con el propósito de tratar las metrorragias y otras afecciones ginecológicas, en el período de tiempo comprendido entre el 1º de enero de 2003 al 31 de diciembre de 2008. Las pacientes incluidas en el estudio se evaluaron semestralmente mediante interrogatorio, examen clínico, estudios hematológicos y ecografía. RESULTADOS: Encontramos una notoria reducción del flujo menstrual, aquellas con más de 12 meses de uso presentaron un incremento de 1 ¢ gr en las cifras iniciales de hemoglobina. Las pacientes con miomas lograron discreta reducción tumoral y control de las metrorragias en tanto se comprobó una reducción en las masas quísticas y los síntomas en las pacientes con endometriosis, en tanto logramos un endometrio lineal en las pacientes en terapia de reemplazo hormonal (TRH). CONCLUSIONES: Los efectos adversos más reportados fueron los relacionados a la acción local del progestágeno sobre el endometrio como son el spotting y la amenorrea, de forma excepcional se reportaron calambres en miembros inferiores, hasta la fecha ninguna usuaria ha interrumpido la utilización de Mirena
The continuous use of active hormonal contraceptives by insertion of intrauterine system releaser of progestational agent (Levonorgestrel) has been very useful due to its desired contraceptive action as well as its positive effect for managing of some gynecological affections including endometriosis, uterine fibromatosis and certain menstrual dysfunctions and adding recently new indications. OBJECTIVE: To assess the usefulness of the intrauterine releaser system Lovenorgestrel (Mirena) in management of metrorrhagies and other gynecological affections. METHODS: A descriptive, longitudinal and prospective study was conducted including 19 patients underwent Mirena insertion to treatment metrorrhagies and other gynecological affections between January 1, 2003 and December 31, 2008. Patients included in study were half-yearly assessed by interviews, clinical examination, hematology studies and echography. RESULTS: There was a market reduction of menstrual flux; those patients with more than 12 months of use had an increase of 1 ¢ gr in first figures of hemoglobin. Patients presenting with myomata achieved a slight reduction of tumor and a metrorrhagies control also verifying a decrease in cystic masses and in symptoms of patients with endometriosis, while it was possible to obtain a linear endometrium in patients under hormone replacement therapy (HRT). CONCLUSIONS: More frequently reported adverse effects were those related to local action of progestogen on endometrium e.g. spotting and amenorrhea. As exception were the lower extremities cramps. Until now no patient has interrupted the use of Mirena