Síndrome de ovario poliquístico: casos confirmados y tratamiento en consulta externa del Hospital Escuela Universitario / Polycystic ovary syndrome: confirmed cases and treatment in the outpatient clinic of ̈Hospital Escuela Universitario

El síndrome de ovario poliquísticoes unaendocrinopatía frecuente en la mujer en edad fértil, causado por exceso de andrógenos y es causa de infertilidad anovulatoria. Actualmente uno de los criterios utilizados para el diagnóstico, son los de Rotterdam y para esto se necesita de la clínica (hiperandrogenismo y disfunción ovulatoria), exámenes de laboratorio (hiperandrogenismo) y/o ultrasonido característico de dicho síndrome. Objetivo:determinar el síndrome de ovario poliquístico confirmado por métodos laboratoriales e imágenes y tratamiento indicado en consulta externa del Hospital Escuela Universitario. Material y métodos: estudio retrospectivo, transversal, no aleatorio. Se revisaron 56 expedientes de pacientes con el diagnóstico de síndrome de ovario poliquístico valorados mediante criterios de Rotterdam, 31(55.4%) tenian diagnóstico ultrasonográfico. Se utilizó un instrumento de recolección de datos tipo cuestionario registrandose lo siguiente: edad, sintomatología, exámenes laboratoriales, diagnóstico con descripción ultrasonográficas y tratamiento farmacológico. Resultados: con el diagnóstico de síndrome ovario poliquístico, 31(55.4%) teníandiagnósticos1 Médico especialista en ginecología y obstetricia, Hospital Escuela Universitario2Estudiante de sexto año, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras.Autor de correspondencia: Silder Moncada Correo electrónico: silderjavier78@gmail.comRecibido: 19/09/2017Aceptado: 07/02/2019ultrasonográficos, en 26(83.9%) pacientes no se encontró consignado en el expediente síntomas de hiperandrogenismo, se consignó acantosis nigricans en 2(6.5%), alopecia y acné 3(9.7%), respectivamente como signo hiperandrogénico. Los fármacos utilizados para tratar síndrome de ovario poliquístico fueron metformina y anticonceptivos orales. Conclusión: el diagnóstico y tratamiento de síndrome de ovario poliquístico no sigue protocolos estandarizados, ya que de los 31 expedientes con resultado por ultrasonido, solo 5(16.1%) reunían los criterios para el diagnóstico de dicha patología...(AU)

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. .

Oral contraceptive-induced high blood pressure is prevented by renin-angiotensin suppression in female rats but not by sympathetic nervous system blockade.

The use of oral contraceptive (OC) steroids is associated with high blood pressure, although mechanisms responsible are still unclear. This study sought to investigate the possible roles that renin-angiotensin system (RAS) and sympathetic nervous system (SNS) may play in the development of OC-induced hypertension. Administration of OC led to significant increases in blood pressure, heart weight and significant decrease in urinary output in OC-treated and OC+clonidine-treated groups but not in OC+captopril-treated group. The pressor response to angiostensin II was significantly greater in the OC-treated rats than in the control rats. However, the pressor responses induced by norepinephrine were not significantly affected by OC administration. The results of the present study demonstrate that OC-induced high blood pressure is associated with cardiac hypertrophy, enhanced pressor response to angiotensin II and preserved pressor response to sympathetic activation. The study also suggests that the development of the OC-induced hypertension and cardiac hypertrophy is mediated by RAS, but not by SNS.

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.

Effect of a new oral contraceptive with drospirenone on vital signs, complete blood count, glucose, electrolytes, renal, and liver function.

OBJECTIVE: To evaluate the effect of a new oral contraception formulation with drospirenone (Yasmin) on vital signs, complete blood count, glucose, electrolytes, and renal and liver function. MATERIAL AND METHOD: An open-label non-comparative clinical trial was conducted. One hundred women who were planning to use oral contraception for at least six months were recruited. The subjects received a blister pack which contained 21 tablets of 3 mg drospirenone /30 tg ethinyl estradiol for the first four cycles (1 cycle = 28 days). Cycle 5 and 6 blister packs were dispensed during the visit in cycle 4. Heart rate and blood pressure of each subject were checked at baseline and each visit. Serum from each subject was collected and sent for complete blood count, glucose, electrolytes, and renal and liver function tests at baseline and at cycle 6. Mean differences in these tests at cycle 6 compared to baseline were assessed. RESULTS: Ninety-two of the 100 subjects (92%) completed the present study. There was no significant change in heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function tests at cycle 6 when compared to baseline. CONCLUSION: Oral contraception formulation with drospirenone (Yasmin) is well tolerated and has good contraceptive efficacy. It is safe, as it has no effect on heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function.

Effect of increased calcium intake on cardiac and vascular Na(+)-K(+)-ATPase activity in oral contraceptive-treated female Sprague-Dawley rats.

The present study aimed at investigating the influence of increased dietary calcium on Na(+)-K(+)-ATPase activity in heart and aorta of female Sprague-Dawley rats treated with oral contraceptive (OC) steroids. Rats were grouped as control (CR), OC-treated and OC+calcium-treated. OC-treated and OC+calcium-treated received a combination of OC steriods (ethinyloestradiol and norgestrel; ig). OC+calcium-treated rats were fed with 2.5% calcium diet, while OC-treated and CR groups were fed on 0.9% calcium diet. The activity of Na(+)-K(+)-ATPase in heart and aorta was significantly lower in OC-treated rats than those in the other groups. OC treatment caused significant increase in plasma glucose and significant decrease in plasma K+ as compared to control group. Decrease in Na(+)-K(+)-ATPase activity and plasma K+ was abrogated by increased calcium intake, while increase in plasma glucose was not normalized by calcium supplementation. Plasma levels of Na+, lipid peroxidation index and ascorbic acid were comparable among the three groups. These results showed that OC treatment could lead to impaired activity of cardiac and vascular Na(+)-K(+)-ATPase, possibly due to reduced plasma K+ level and these effects could be abolished by high calcium diet.

Serum copper in rural women taking combined oral contraceptive.

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.

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.

Difference in bone acquisition among hormonally treated postmenopausal women with normal and low bone mass.

This prospective analysis was conducted to compare the effects of hormone treatments on bone mineral density (BMD) of the lumbar spine, hip, and distal forearm in postmenopausal women with normal BMD and those with low bone mass. Eighty healthy women were randomly assigned to receive a cyclic regimen of standard hormone replacement therapy (HRT) or currently used low-dose oral contraceptive (OC). Women were categorized as normal BMD and low bone mass according to the Thai reference database. The results revealed that women with low bone mass gained more BMD than those with normal BMD. The difference in mean per cent bone acquisition was obvious at the spine. In addition, further subset analysis into OC and HRT groups revealed higher effects of OC on BMD when compared to HRT.

Effect of oral and injectable contraceptive on serum cacium magnesium and phosphorus in women

This study aims at evaluating serum calcium, magnesium and phosphorus levels in women taking oral and injectable contraceptives. Serum calcium, magnesium and phosphorus were measured in 50 women taking oral contraceptives [Lofeminal] and 50 women taking injectable contraceptive [Depo-medroxy progesterone acetate and Norigest]. These women were used as controls before starting these contraceptives. There was significant decrease in serum levels of calcium, magnesium and phosphorus in women taking oral contraceptives but there was significant increase in these minerals in women taking injectable contraceptives. Conclusions: It is suggested that these contraceptives should be used with due care and with proper investigations of the women before and during the therapy

Anti-fertility activity and hormonal profile of trans-anethole in rats.

Trans-anethole was studied for antifertility activity in rats at dose levels of 50 mg, 70 mg and 80 mg/kg po. Dose-dependent activity was observed, a 100% anti-implantation activity being achieved at 80 mg/kg, po. The compound showed a significant estrogenic activity and did not possess anti-estrogenic, progestational, anti-progestational, androgenic or anti-androgenic activities. In an earlier study, the compound was found to be safe, its LD50 being more than 3000 mg/kg, po in mice.

Alteraçöes no metabolismo dos carboidratos em usuárias de esteróides sexuais / Changes in carbohydrates netabolism in women who use sexual steroids

Tem sido mostrado em mulheres usuárias de esteróides sexuais, que os progestagênios säo os principais responsáveis pelas alteraçöes no metabolismo dos carboidratos. A intolerância à glicose observada nestas mulheres é causada principalmente por uma resistência periférica à insulina, com conseqüente hiperinsulinemia, pela elevaçäo nos níveis de GH e glicocorticóides, além de anormalidades no metabolismo hepático. Entretanto, as alteraçöes no metabolismo dos carboidratos podem ser minimizadas ou eliminadas com mudanças nas preparaçöes e/ou nas doses das drogas usadas nos anticoncepcionais orais (ACO)

Anticoncepcionais orais / Oral contraceptive agents

Esta pequena revisäo aborda a classificaçäo, mecanismos de açäo e outras açöes dos anticoncepcionais orais. O autor inclui também sua experência no emprego destes produtos, bem como sua conduta em situaçöes controversas ou de contra-indicaçöes deste método de contracepçäo

Contracepçäo oral e coagulaçäo / Oral contraception and coagulation

Os autores fazem uma revisäo sobre os anticoncepcionais orais e seus efeitos sobre a coagulaçäo sanguínea. Abordam aspectos fisiológicos da hemostasia, coagulaçäo e trombose. Analisam pormenorizadamente os fatores de risco para trombose em usuárias dos anticonceptivos orais e relatam as principais conclusöes de interesse prático para o dia a dia do ginecologista