Effects of different add-back regimens on hypoestrogenic problems by postoperative gonadotropin-releasing hormone agonist treatment in endometriosis

OBJECTIVE: To compare the efficacy of different add-back regimens on hypoestrogenic symptoms during postoperative gonadotropin-releasing hormone (GnRH) agonist treatment in endometriosis patients. METHODS: This prospective cohort study included reproductive-aged women who underwent conservative laparoscopic surgery for ovarian endometriosis and received add-back therapy during a 6-month course of GnRH agonist therapy after surgery. Participants received one of four different add-back regimens: 1 mg of estradiol valerate, 2.5 mg of tibolone, or a combination of 1 mg of estradiol and 2 mg of drospirenone or 0.5 mg of norethisterone acetate. Changes in quality of life, hypoestrogenic symptoms, and bone mineral density were compared according to add-back regimens. RESULTS: A total of 57 participants completed a 6-month course of GnRH agonist and add-back therapy. All components of quality of life did not differ across groups. However, within the same treatment group, social relationship factors decreased significantly with estradiol valerate and tibolone alone, and environmental factors decreased significantly with estradiol valerate alone. Menopausal Rating Scale score did not change significantly, but the incidence of hot flushes significantly decreased with a combination of estradiol and norethisterone acetate. Bone mineral densities at the lumbar spine declined significantly after treatment in all groups except with a combination of estradiol and norethisterone acetate. CONCLUSION: This preliminary study suggests that an add-back regimen containing estradiol valerate and norethisterone acetate may have better efficacy in terms of quality of life, hypoestrogenism-associated symptoms, and bone mineral density.

What is the influence of hormone therapy on homocysteine and crp levels in postmenopausal women?

OBJECTIVE: To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women. METHODS: In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol), Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate) and Group C received a placebo (control). The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy. RESULTS: After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels. CONCLUSION: Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin) may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels. .

Norethindrone-induced masculinization and progeny testing in guppy, Poecilia reticulata (Peters 1859).

Norethindrone(NE) was evaluated for its efficacy on alteration of sex ratio of P. reticulata. Either the young fry or the brooders and the resultant fry were fed a commercial diet incorporated with NE at 0, 25, 50, 75 and 100 mg kg-1 diet (ppm) for 30-40 d in rectangular glass aquaria; this was followed by 40-60 d rearing on NE-free diet in out-door concrete tanks. In general, the androgen treatment altered sex ratio, leading to the production of a dose dependent increase in the percentage of males. The oral administration of the steroid at 75 ppm for 40 d or 100 ppmfor 30 or 40 d to first feeding fry, yielded 100% males. On the other hand, NE administration to brooders before parturition and the resultant fry also produced an all-male population of guppy. The sex ratio of the untreated control was almost 1:1. The survival of fish in all the trials was high, ranging between 67 and 100%. Mating masculinized males (“XX” male) with normal female resulted in an all-female progeny, while crossing normal male (XY) from treatment groups with normal female sired normal sex ratio (1:1), elucidating XX-XY sex determination system in the guppy.

LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial / 부인종양

OBJECTIVE: To compare the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) and oral norethisterone acetate (NET) for treatment of non-atypical endometrial hyperplasia in perimenopausal women. METHODS: One hundred and twenty perimenopausal women with non-atypical endometrial hyperplasia were selected in this randomized controlled trial. Patients received LNG-IUS (n=59) or NET (n=61; 15 mg/day for 3 weeks/cycle) for 3-6 months. Outpatient follow-up with endometrial biopsies were undertaken at 3, 6, and 12 months intervals after treatment. Outcome measures were; the regression rate, the time to regression and hysterectomy rate. RESULTS: A significantly higher regression rate was noted in the LNG-IUS group than in NET group at the 3rd, 6th and 12th month follow-up visits using intention-to-treat analysis (67.8% vs. 47.5%, relative risk [RR], 1.42; 79.7% vs. 60.7%, RR, 1.31; and 88.1% vs. 55.7%, RR, 1.58, respectively). However, no significant difference was found regarding the median time to regression (3 months). The hysterectomy rate during the follow-up period was significantly higher in the NET group (57.4% vs.22%, p<0.001). CONCLUSION: LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women is more effective than NET for achieving disease regression for the majority within 1 year. Moreover, it can reduce the number of hysterectomies performed.

Attitudes and experiences of women admitted to hospital with abortion complications in Ghana

Unsafe abortion is one of the major contributors to high levels of maternal mortality in Ghana, despite a relatively liberal legal environment. This paper presents findings from a semi-structured hospital-based survey of 131 Ghanaian women who had experienced unsafe abortion. The majority of respondents were young and single, with no children or just one child. Most had middle-school education or higher and were employed, as were their partners. While knowledge of family planning was high, knowledge of specific methods was barely moderate and only 17% respondents had ever used it ­ much lower than the national everuse of 39%. There were widespread misunderstandings about who could use family planning and 41% said they were afraid of sideeffects. Eleven percent said their pregnancy was planned and 31% that they wanted their pregnancy but were pressured by partners or families to abort. Overall, about one-third of respondents said they aborted because they were not married and two-thirds said they aborted because of socio-cultural pressures. This study highlights clear ongoing failings of the family planning programme which needs to be revamped, as well as an urgent need for improving public knowledge about access to safe, legal abortion services (Afr J Reprod Health 2011; 15[1]: 47-55)

A study of the use of Primolut N Tablet as a contraceptive in the Kumasi Metropolis of Ghana

This study investigated the use of Primolut N tablet which contains norethisterone 5mg popularly called N- tablet by users as a precoital contraceptive by women in the Kumasi metropolis of Ghana. Clients who called at any of the twenty (20) selected Pharmacies in residential areas within the Kumasi metropolis demanding the drug, with or without valid prescriptions were interviewed using a guide. Of the two hundred and twenty (220) users interviewed, 94% demanded the drug for contraception and 6% for menstrual disorders. Sixty one percent of those demanding it for contraception were between the ages 20-25 years. Respondents preferred the use of norethisterone tablets as a contraceptive to other methods because it worked for them and they also found it easy and convenient taking a tablet just before coitus than taking daily oral contraceptive pills. Norethisterone is being used as a pre-coital contraceptive, though the efficacy, safety and reliability of the drug for that purpose is unknown. Until these are known, women must be discouraged from using the drug (Afr J Reprod Health 2011; 15[1]: 65-67)

Efectos del estradiol y acetato de noretisterona sobre los lípidos y la lipoproteína (a) sérica en posmenopáusicas ooforectomizadas / Effects del estradiol and norethisterone acetate on lipids and serum lipoprotein (a) in oophorectomized postmenopausal women

Determinar los efectos del estradiol y acetato de noretisterona sobre el perfil lipídico y la lipoproteína (a) en posmenopáusicas sanas ooforestomizadas. Se incluyeron treinta y seis mujeres sometidas a histerectomía y salpingo-ooforectomía bilateral con sintomas climatéricos. Las posmenopáusicas fueron tratadas con 2 mg de estradiol y 1 mg de acetato de noretisterona diario por 12 meses. Se midieron las concentraciones séricas de triglicéridos, HDL colesterol. LDL colesterol y colesterol y lipoproteína (a) al inicio del estudio y a los 3, 6, 9 y 12 meses de tratamiento. Hospital Central "Dr. Urquinaona", Maracaibo. No se observaron cambios estadísticamente significativos de colesterol, triglicéridos y LDL colesterol después de 3, 6, 9 y 12 meses de tratamiento cuando se comparó con los valores iniciales (P = ns). Desde los primeros 3 meses de tratamiento se observo un incremento en los valores de HDL colesterol (P < 0,05). Durante los primeros 3 meses de tratamiento los niveles de lipoprotéina (a) no variaron en forma significativa (P = ns). A partir de los 6 meses de tratamiento y a los 9 y 12 meses, estos niveles séricos se incrementaron en forma estadísticamente significativa cuando se compararon con los valores iniciales (P < 0,05). La administración oral de estradiol y acetato de noretisterona produce cambios significativos en los niveles de HDL colesterol y lipoprotéina, sin afectar las concentraciones séricas de colesterol, triglicéridos y LDL colesterol en pomenopáusicas ooforectomizadas

Concentraciones de estradiol y acetato de noretisterona y mediciones antropométricas en menopáusicas obesas y no obesas / Estadiol and norethisterone acetate concentrations and antropometric measures in obese and non-obese menopausal women

Determinar los efectos de la combinación estradiol y acento de noretistero sobre las concentraciones hormonales y las mediciones antropométricas en menopáusicas obesas y no obesas. Consulta de menopausia del Hospital Central Dr. Urquinaona". Maracaibo. Se seleccionaron 60 menopáusicas, treinta de las cuales fueron tratadas con 2 mg de estradiol y 1 mg de acetato de noretisterona diario. El grupo de mujeres no utilizaba ni tenia antecedentes del uso de ningún tipo o combinación de terapia hormonal de reemplazo. Se determinaron el peso, talla, estrona, estradiol, hormona del crecimiento, factor 1 similar a la insulina, cortisol y androstenodiona. La estrona y el estradiol fueron mayores en los usuarios de estradiol y acetato de noretisterona comparado con las no usuarias (P<0.05). Las obesas usuarias de la combinación tenían mayores concentraciones de estradiol que las usuarias no obesas (P<0.05). Las no obesas usuarias de la combinación tenían concentraciones mayores de hormona de crecimiento que el resto de las menopásicas (P<0,05). Las concentraciones de factor 1 similar a la insulina fueron significativamente menores en las obesas usuarias de la combinación (P>0,05). Las no obesas usuarias de estradiol y acetato de noretisterona tenían concentraciones de cortisol significativamente mayores (p<0,05). El uso de estradiol y acetato de noretisterona produce un aumento significativo en las concentraciones de hormona del crecimiento y cortisol con concentraciones significativamente más bajos de factor 1 similar a la insulina en las menopáusicas no obesas. La combinación debe ser utilizada de forma racional en las menopáusicas obesas debido a las altas concentraciones séricas estrógenos que se observan

Avaliação do tratamento hormonal e/ou intervencionista por punção nos tumores císticos de ovários / Evaluation of hormonal treatment and/or intervention through aspiration of ovarian cystic tumors

Objetivo: O objetivo deste estudo foi avaliar em mulheres com tumores císticos de ovário, a proporção que, somente com o tratamento clínico e/ou punção, não necessitaram de cirurgia; a influência da medicação e das doenças associadas na indicação de cirurgia e se a punção reduziu significativamente o tamanho dos cistos. Casuística e métodos: Selecionaram-se 71 mulheres com idade entre 19 e 70 anos de idade, portadoras de tumores císticos de ovário maior que 5 cm, com características de benignidade ao ultra-som transvaginal com Doppler colorido e pulsado e com perfil endócrino e marcadores séricos tumorais normais. Foram divididas em cinco grupos: 1) Grupo A: 15 mulheres que fizeram uso de acetato de noretisterona; 2) Grupo B: 13 mulheres que fizeram uso de acetato de medroxiprogesterona; 3) Grupo C: 14 mulheres que utilizaram contraceptivo oral; 4) Grupo D: 15 mulheres que foram tratadas com análogo de GnRH e 5) Grupo E: 14 mulheres que não fizeram uso de medicação. Todos os grupos foram acompanhados por um ano. No final do primeiro trimestre, se o cisto persistiu, foi realizada a punção. No final do segundo trimestre, se houve recidiva do cisto, foi indicada cirurgia. As pacientes tiveram alta após um ano de acompanhamento com o tratamento do cisto concluído. Resultados: Não houve diferenças significantes entre os cinco grupos. Constatou-se que a condição de uso de medicação para doença associada teve influência significativa no resultado dos tratamentos. Verificou-se que a redução do tamanho do cisto com a punção foi efetiva após 9 meses de acompanhamento. Observou-se que 7% das mulheres tiveram indicação direta para cirurgia sem a punção, portanto, a proporção de recidiva da punção foi de 19,3% enquanto a porcentagem de mulheres que não fizeram a cirurgia foi de 73,2%. Conclusão: A proporção de mulheres que responderam adequadamente somente com o tratamento clínico e/ou a punção, não necessitando pois de cirurgia foi de 73,2%...

Objectives: To evaluate the rate of women with ovarian cystic tumors submitted to diferent regimens of hormonal treatment and/or aspiration that didn’t need surgery. To access the effectiveness of ovarian cyst aspiration guided by ultrasonography (USG) and to study the influence of medication and associated diseases in the need for surgery. Patients and Methods: Seventy one (71) women, in an age range from 19 to 70 years, diagnosed with ovarian cysts larger than 5 cm in length, with benign aspect, examined using an ultrasonographic transvaginal probe and color Doppler. All the women have been submitted to measurements of ser um tumor markers and hormonal levels. They were grouped in five different categories: 1) Group A: 15 women treated with noretisterone acetate; 2) Group B: 13 subjects treated with medrooxiprogesterone acetate; 3) Group C: 14 patients treated with combined oral contraceptive; 4) Group D: 15 women treated with GnRH analog, and 5) Group E: 15 women with no treatment control). After 3 months, all the patients were reevaluated. In those ones whose cysts remained, cyst aspiration guided by ultrasonography was indicated. After 3 extra months, the women were submitted to a new USG examination and in those whose cysts still remained, surgery was performed. All the patients were followed for one year. Results: There was no significant difference among the groups of hormonal treatment. The use of medication promoted a significant influence in the treatment outcomes. We also noted that the cyst aspiration was effective in reducing the size of the cysts after 9 months of follow up. Seven per cent (7%) of the patients have had immediate indication for surgery. Among those who was submitted to cyst aspiration, 19.3% had to be resubmitted to treatment because of re-incidence of the cyst, whereas, 73.2% avoid the need for surgery. Conclusions: The proportion of subjects treated with hormones and/or cyst aspiration, with no need for surgery, was of 73.2%...

Efecto de la combinación estradiol - acetato de noretisterona sobre los niveles de proteína C reactiva en menopáusicas ooforectomizadas / Effect of combined estradiol-noretisterone acetate on reactive protein C levels in ooforectomized women

Determinar el efecto de combinación estradiol y acetato de noretisterona sobre los niveles de proteína C reactiva en menopáusicas ooforectomizadas. Se incluyeron treinta y seis pacientes, sometidas a histerectomía y salpingo-ooforectomía bilateral con síntomas climatéricos. Las pacientes tratadas con 2 mg de estradiol y 1 mg de acetato de noretisterona diario. Se midieron los niveles de proteína C reactiva sérica al inicio del estudio y a los 3,6,9 y 12 meses. Hospital Central "Dr. Urquinaona". Maracaibo Estado Zulia. Se observó aumento de la proteína C reactiva a los 3 meses, pero no fue considerado significativo (p>0,05). Posteriormente, no se observaron variaciones significativas a los 6,9 y 12 meses con relación al valor inicial (p>0,05). La administración oral de estradiol y acetato de noretisterona no produce aumento de los niveles de proteína C reactiva en pacientes menopáusicas ooforectomizadas, lo cual podría contribuir al beneficio cardiovascular de las usuarias de terapia hormonal de reemplazo combinada

Terapia de reposição hormonal (TRH) em mulheres hipertensas: avaliação de preparado injetavel mensal / Hormonal replacement therapy in hypertensive women: evaluation of the effects of a monthly injectable preparation

Avaliar os efeitos de um preparado injetavel mensal contendo enantato de noretisterona 50 mg + valerato de estradiol 5 mg, sobre os niveis pressoricos e...

Efeito do tratamento hormonal com estradiol e acetato de noretisterona de forma continua sobe o volume uterino e a espessura endometrial em mulheres menopausadas / Hormonal treatment effect with continuous estradiol and noretisterone acetate over the uterine volume and endometrial thickness in menopausal women

Analisar o efeito do tratamento com a associacao de 2 mg de estradiol e 1 mg de acetato de noretisterona por via oral de forma continua em mulheres menopausadas sobre...

Efeitos do gérmen de soja e da terapia de reposição hormonal sobre a formação de metabólitos do `ANTPOT. PONTO´NO, lipoproteínas oxidadas, anticorpos antiproteínas de choque térmico e reatividade vascular em mulheres pós-menopausa hipercolesterolêmicas / Soy germ and of the therapy of hormonal replacement effects about the formation of metabolics of the `ANTPOT. PONTO´NO, oxidized lipoprotein, antibodies anti-heat shock proteins and vascular reactivity in hypercolesterolemic postmenopausal women

A interrupção da produção ovariana do estrogenio ocorrida na menopausa aumenta o risco de doença cardiovascular. Pelo fato da reposição de estrogênios induzir proliferação endometrial e aumentar o risco de câncer de mama e de doenças cardiovasculares, tem-se pesquisado alternativas para a terapia de reposição hormonal. Os fitoestrogênios são compostos fenólicos de origem vegetal, que possuem similaridade estrutural com os estrogênios. As isoflavonas genisteína, daidzeína egliciteína, presentes na soja, têm se destacado por seus efeitos estrogênico, antioxidante e de inibição da agregação plaquetária. O objetivo deste trabalho foi avaliar o efeito dos fitoestrogênios da soja e da terapia de reposição hormonal sobre a reatividade vascular, formação de derivados do óxido nítrico, oxidação de lipoproteínas e anticorpos anti-proteínas de choque térmico (HSPs) em mulheres pós-menopausa hipercolesterolêmicas...

Efeitos de um implante de acetato de nomegestrol, um derivado de 19-nor-progesterona, na função tireoidiana / Effects of an implant of nomegestrol acetate, a 19-nor-progesterone derivative, on thyroid function

Este estudo foi realizado para avaliar tri-iodotironina (T3), tiroxina (T4), hormônio estimulante da tireóide (TSH), T3 uptake, T3 livre e T4 livre em usuárias do implante de acetato de nomegestrol (Uniplant). Dezoito voluntárias em idade reprodutiva, que desejavam fazer anticoncepção, foram recrutadas para o estudo e investigadas antes do início do tratamento. Amostras de sangue foram obtidas antes da inserção do implante, para análises hormonais. Em seguida, amostras de sangue foram colhidas 3,6,12 e 24 meses após a inserção do Uniplant. Todas as pacientes usaram contraceptivo não hormonal por um período mínimo de 6 meses, antes da inserção do implante. Os resultados observados no estudo mostraram que não houve diferença significante na tri-iodotironina (T3), tiroxina (T4) e hormônio estimulante da tireóide (TSH), durante dois anos de uso do Uniplant. Nenhuma diferença significante foi encontrada nos níveis de T3 livre, durante dois anos de uso do Uniplant. Um decréscimo significante foi abservado no T3 uptake (p<0,05) no 24º mês e no T4 livre (p<0,05) no 3º mês de uso do Uniplant. todas as alterações observadas no estudo foram inconsistentes e todos os níveis estavam dentro dos limites normais.

Efeitos do estradiol isolado e associado ao acetato de noritisterona sobre a rigidez arterial em mulheres hipertensas após a menopausa / Effects of estradiol isolated and combined with norethisterone acetate on the arterial stiffness in hypertensive postmenopausal women

Muitas investigações relatam maior prevalência na Doença Cardiovacular (DCV), no período após a menopausa, e dentre as DCV está a hipertensão arterial (HA). O aumento crônico da pressão arterial e as flutuações nas concentrações séricas dos estrogênios exercem importante impacto sobre a parede arterial resultando em perturbação, na elasticidade e rigidez arterial (RA). Por isso, avaliou-se a rigidez arterial, em 45 mulheres hipertensas após menopausa / High prevalence of Cardiovascular Disease (CVD) has been frequently reported in postmenopausal women, among the CVDs is the arterial hypertension. It is well know that chronic high arterial pressure (AP) and the fluctuation in estrogen serum levels exert a critical impact on the arterial wall, resulting in disturbances in elasticity and stiffness. Therefore, the goal of this study was to evaluate the arterial stiffness (AS) ,in 45 hypertensive postmenopausal women...

Regulation of Estrogen Receptor and Progesterone Receptor Expression by Estrogen and Progesterone/Progestogen in Human Umbilical Vein Endothelial Cells / 대한산부인과학회잡지

OBJECTIVE: Observational studies showed a significant reduction in cardiovascular disease (CVD) among postmenopausal hormone replacement therapy (HRT) users. But recent randomized clinical trial reported that HRT does not decrease, and may in fact, increase the incidence of CVD. Progestogen may in part contribute the increased risk but the exact role of different progestogens in the development of CVD is still unclear. The aim of this study was to investigate the effects of progesterone/progestogen and combination with estrogen on the regulation of estrogen and progesterone receptor m RNA expression in vascular endothelial cells to provide a basis to analyze the direct steroid effects on CVD. METHODS: Human Umbilical Vein Endothelial Cells (HUVEC) were cultured for 24 hours. Media were supplemented with estradiol (E2) (10(-7)M), progesterone (P4) (10(-7)M), medoxy-progesterone acetate (MPA) (10(-7)M), norethindrone acetate (NETA) (10(-7)M) and RU 486 (10(-6)M) alone or in combination. Receptor expression (estrogen receptor alpha and progesterone receptor total and isoform B) was examined at the mRNA level by reverse transcription-PCR. RESULTS: Total progesterone receptor expression was decreased after NETA treatment. E2, P4, MPA, NETA increased expression of PRB. PRB expression was more increased in E2 combined with P4 and MPA, than single treatment. PRB down regulation was found when RU 486 was additionally supplemented into the medium. ER expression was decreased after E2, P4, and MPA treatment. When MPA was added to E2, ER was more down reguated than the addition of P4 and NETA. RU 486 prevented down reguation of MPA on ER alpha. CONCLUSION: These findings suggested that MPA compared to P4 and NETA, may attenuate the favorable effect of estrogen on vasular endothelium.