Comparison of the effects and safety of dydrogesterone and medroxyprogesterone acetate on endometrial hyperplasia without atypia: a randomized controlled non-inferior phase Ⅲ clinical study / 中华妇产科杂志

Objective: To compare the effects and safety of dydrogesterone (DG) and medroxyprogesterone acetate (MPA) on the treatment in patients with endometrial hyperplasia without atypia (EH). Methods: This was a single-center, open-label, prospective non-inferior randomized controlled phase Ⅲ trial. From February 2019 to November 2021, patients with EH admitted to the Obstetrics and Gynecology Hospital of Fudan University were recruited. Enrolled patients were stratified according to the pathological types of simple hyperplasia (SH) or complex hyperplasia (CH), and were randomised to receive MPA or DG. Untill May 14, 2022, the median follow-up time after complete response (CR) was 9.3 months (1.1-17.2 months). The primary endpoint was the 6-month CR rate (6m-CR rate). The secondary endpoints included the 3-month CR rate (3m-CR rate), adverse events rate, recurrence rate, and pregnancy rate in one year after CR. Results: (1) A total of 292 patients with EH were enrolled in the study with the median age of 39 years (31-45 years). A total of 135 SH patients were randomly assigned to MPA group (n=67) and DG group (n=68), and 157 CH patients were randomly assigned to MPA group (n=79) and DG group (n=78). (2) Among 292 patients, 205 patients enrolled into the primary endpoint analysis, including 92 SH patients and 113 CH patients, with 100 patients in MPA group and 105 in DG group, respectively. The 6m-CR rate of MPA group and DG group were 90.0% (90/100) and 88.6% (93/105) respectively, and there were no statistical significance (χ2=0.11, P=0.741), with the rate difference (RD) was -1.4% (95%CI:-9.9%-7.0%). Stratified by the pathology types, the 6m-CR rate of SH patients was 93.5% (86/92), and MPA group and DG group were respectively 91.1% (41/45) and 95.7% (45/47); and the 6m-CR rate of CH patients was 85.8% (97/113), and MPA group and DG group were 89.1% (49/55) and 82.8% (48/58) respectively. The 6m-CR rates of the two treatments had no statistical significance either (all P>0.05). A total of 194 EH patients enrolled into the secondary endpoint analysis, including 88 SH patients and 106 CH patients, and 96 patients in MPA group and 98 in DG group, respectively. The 3m-CR rate of SH patients were 87.5% (77/88), while the 3m-CR rates of MPA group and DG group were 90.7% (39/43) and 84.4% (38/45), respectively; the 3m-CR rate of CH patients was 66.0% (70/106), and MPA group and DG group had the same 3m-CR rate of 66.0% (35/53). No statistical significance was found between the two treatments both in SH and CH patients (all P>0.05). (3) The incidence of adverse events between MPA group and DG group had no statistical significance (P>0.05). (4) A total of 93 SH patients achieved CR, and the cumulative recurrence rate in one year after CR were 5.9% and 0 in MPA group and DG group, respectively. While 112 CH patients achieved CR, and the cumulative recurrence rate in one year after CR were 8.8% and 6.5% in MPA group and DG group, respectively. There were no statistical significance between two treatment groups (all P>0.05). Among the 93 SH patients, 10 patients had family planning but no pregnancy happened during the follow-up period. Among the 112 CH patients, 21 were actively preparing for pregnancy, and the pregnancy rate and live-birth rate in one year after CR in MPA group were 7/9 and 2/7, while in DG group were respectively 4/12 and 2/4, and there were no statistical significance in pregnancy rate and live-birth rate between the two treatment groups (all P>0.05). Conclusions: Compared with MPA, DG is of good efficacy and safety in treating EH. DG is a favorable alternative treatment for EH patients.

Dietary intake and eating behavior in depot medroxyprogesterone acetate users: a systematic review

Because of weight gain, women often discontinue hormonal contraception, especially depot medroxyprogesterone acetate (DMPA). Our objective was to conduct a systematic review of studies describing dietary intake or eating behavior in DMPA users to understand whether the use of DMPA is associated with changes in dietary habits and behaviors leading to weight gain. We searched the PubMed, POPLINE, CENTRAL Cochrane, Web of Science, and EMBASE databases for reports published in English between 1980 and 2017 examining dietary intake or eating behavior in healthy women in reproductive age and adolescents using DMPA (150 mg/mL). Of the 749 publications screened, we excluded 742 due to duplicates (96), not addressing the key research question (638), not reporting dietary intake data (4), and not evaluating the relationship of body weight and dietary or eating behaviors (4). We identified seven relevant studies, including one randomized placebo-controlled trial, one non-randomized paired clinical trial, and five cohort studies. The randomized trial found no association and the other reports were inconsistent. Findings varied from no change in dietary intake or eating behavior with DMPA use to increased appetite in the first six months of DMPA use. Few studies report dietary intake and eating behavior in DMPA users and the available data are insufficient to conclude whether DMPA use is associated with changes in dietary habits or behavior leading to weight gain.

Quantification of collagen fibers in canine uteri treated with medroxyprogesterone acetate

Collagen plays essential roles in remodeling uterine tissue during decidualization, implantation, pregnancy and involution. To understand whether the progestational agent medroxyprogesterone acetate (MPA) can modify the organization and deposit of collagen in the uteri of normal bitches (Canis Tlupus familiaris), we assessed uterine tissues by histochemistry. Uteri were grouped as: nulliparous (n=11), multiparous (n=11) and treated with MPA (n=11; nulliparous with two treatments; 5mg/kg; i.m.). The amount, location and birefringence of interstitial collagen types I and III in the fold and base of the endometrial stroma and the myometrial muscular layers were studied on sections stained with Picrosirius Red by polarized light microscopy and evaluated by ANOVA. No differences were observed in the endometrium. In the myometrium, differences were observed in collagen type I between MPA-treated and nulliparous uteri vs. multiparous (p<0.05), and differences in collagen type III between nulliparous and multiparous uteri vs. MPA-treated (p=0.0001). In conclusion, two doses of MPA had no significant effect on the investigated collagens in the extracellular matrix.(AU)

Gasto energético e medidas antropométricas de novas usuárias do contraceptivo injetável trimestral de acetato de medroxiprogesterona de depósito / Energy expenditure and anthropometric measurements in new users of depot medroxyprogesterone acetate

Objetivo:Avaliar o gasto energético e as medidas antropométricas de mulheres durante o primeiro ano de uso do método contraceptivo de acetato de medroxiprogesterona de depósito.Métodos:Estudo prospectivo com grupo de comparação. Foram incluídas mulheres saudáveis, não obesas, nunca usuárias de acetato de medroxiprogesterona de depósito e sem antecedentes que pudessem contribuir para a variação do peso corporal; foram distribuídas em dois grupos, 28 usuárias de acetato de medroxiprogesterona e 24 usuárias de dispositivo intrauterino de cobre, pareadas por idade (±1 ano) e índice de massa corporal (kg/m2). As variáveis estudadas foram sociodemográficas (idade, etnia, tabagismo, etilismo, atividade física, classe econômica e escolaridade), peso (kg), índice de massa corporal, gasto energético basal e total, medidas de circunferência de cintura e quadril (cm) e relação cintura-quadril.Resultados:A idade das mulheres variou de 20-39 anos. As médias de idade/índice de massa corporal foram 29,6 (DP=±5,2) anos/23,9 (±3,6 kg/m2), no grupo de acetato de medroxiprogesterona de depósito, e de 28,6 (DP=±5,2) anos/ 24,5 (±2,7 kg/m2), no grupo de dispositivo intrauterino de cobre. Após análise de variância para medidas repetidas, as usuárias de acetato de medroxiprogesterona de depósito apresentaram ganho de 2,2 kg no peso corporal e de -0,2 kg no grupo do dispositivo intrauterino de cobre, sem diferença estatisticamente significativa entre eles. Não houve discrepância nas demais variáveis estudadas.Conclusão:Mulheres saudáveis e jovens não apresentaram mudança no peso, nas medidas e nos gastos energéticos durante o primeiro ano de uso do contraceptivo acetato de medroxiprogesterona. A orientação em relação aos hábitos saudáveis de vida e o monitoramento de medidas são importantes para o controle do peso corporal em usuárias de métodos contraceptivos.

Objective:The objective of this study was to assess energy expenditure and the anthropometric profile of women during the first year of use of depot medroxyprogesterone acetate contraception.Methods:This prospective study included healthy non-obese women who had never used depot-medroxyprogesterone acetate and did not have a history of weight fluctuations. The women were divided into two groups composed of 28 depot medroxyprogesterone acetate users and 24 copper intrauterine device (TCu380A) users. They were paired for age (+1 year) and body mass index (+1 kg/m2). The following variables were used: sociodemographic characteristics (age, ethnicity, smoking status, alcohol consumption, physical activity, economic class, and education level), weight (kg), body max index, resting and total energy expenditure, waist and hip circumferences (cm), and waist-to-hip ratio.Results:The age of the women studied ranged from 20-39 years. The mean values of age/body mass index ratio were 29.6 (SD=+5.2) years/23.9 (+3.6 kg/m2) in the depot medroxyprogesterone acetate group and 28.6 (SD=+5.2) years/24.5 (+2.7 kg/m2) in the intrauterine device group. After conducting repeated measures analysis of variance, the users of depot medroxyprogesterone acetate showed weight gain of 2.2 kg, and those in the intrauterine device group showed weight loss of 0.2 kg without statistically significant difference between the groups. There were no significant differences between the other variables.Conclusion:There were no changes in weight, anthropometric measurements, and energy expenditure in the young and healthy women during the first year of use of depot medroxyprogesterone acetate contraception. Guidelines and recommendations for a healthy lifestyle to avoid changes in the anthropometric measurements are important for weight control in users of contraceptive methods.

Chemical Castration for Sexual Offenders: Physicians' Views

No abstract available.

Occurrence of Budd-Chiari syndrome as adverse effect of long term DMPA injections: a case report and review the literatures

Budd-Chiari syndrome [BCS] refers to thrombosis of hepatic veins as well as intrahepatic or suprahepatic inferior vena cava. We present for the first time a case of possible occurrence of Budd-Chiari syndrome with the history of depot medroxy progesterone acetate [DMPA] injections in a 33-year-old Iranian woman. An underlying disorder can be identified in most of patients with BCS. Many of these disorders are characterized by a hypercoagulable state, but it may occur due to other unknown pathophysiologic factors. Also, medical evaluation was performed for inflammatory, immunologic, and thrombotic disorders as well as hepatic imaging. Considering different case reports like this study may help to decrease the percentage of idiopathic cases

Impacto dos contraceptivos hormonais na densidade óssea: evidências atuais para contracepção na adolescência / Impact of hormonal contraceptives on bone density: current evidences for contraception in adolescence

Devido aos efeitos adversos dos contraceptivos hormonais, algumas mulheres são privadas de seus benefícios, que se estendem além da contracepção. Especialmente em adolescentes, é preocupante o impacto dos hormônios sobre o osso. Buscando reunir evidências nesse sentido, três revisores independentes fizeram buscas nas bases de dados Medline, Lilacs, Ibecs, Scielo e Cochrane, utilizando descritores relacionados à contracepção e densidade óssea. Foram critérios de inclusão: revisões sistemáticas e estudos com nível de evidência A e B. Foram excluídos estudos com contraceptivos utilizados para fins terapêuticos e não contraceptivos. Das 66 publicações encontradas, foram selecionados 15 estudos, e evidenciou-se que compostos com progesterona isolada de depósito e possivelmente os de baixa dose estrogênica têm impacto negativo na fase do pico de massa óssea. Contudo, o efeito esteve restrito à idade de iniciação e ao tempo de uso, havendo recuperação após interrupção da contracepção. Não há evidências de relação entre uso de contraceptivos e fraturas. O aconselhamento contraceptivo deve considerar o efeito negativo que a progesterona isolada de depósito e a baixa dose estrogênica podem ter sobre a massa óssea na adolescência, considerando que tal efeito é reversível e limitado ao tempo de uso

Due to the adverse effects of hormonal contraceptives, some women are deprived of the benefits they provide that extend beyond contraception. In adolescents, the main concern is the impact hormones can have on their bone structure. Three independent reviewers researched the databases Medline, Lilacs, Ibecs, Scielo and Cochrane, by using descriptions related to contraception and bone density. The inclusion criteria were: systematic reviews and studies with levels of evidence A and B. Contraceptives used for therapeutic purposes, other than contraception itself, were excluded from the study. Of the 66 publications found, 15 studies were selected. Compounds isolated from progesterone deposit, and possibly the low-dose estrogen, have a negative impact on the stage the bone mass peaks, but the effect was restricted to the age of initiation and the time of use, with recovery after discontinuation of contraception. There is no evidence of a relationship between the use of contraceptives and bone fractures. The negative effects that the deposit of progesterone and low-dose estrogen may have on bone mass should be taken into account when adolescents engage in the use of contraceptives ? bearing in mind that said effects are reversible and limited to the time of use

Effects of Long-term Use of Depo-medroxyprogesterone Acetate on Lipid Metabolism in Nepalese Women / 대한진단검사의학회지

Various synthetic progestogens that are used as contraceptives have been reported to influence lipid and lipoprotein fractions differently. Depo-medroxyprogesterone acetate (DMPA), a synthetic progestogen, is used by Nepalese women as a contraceptive agent. Our study aims to determine the effects of long-term use of DMPA on lipid metabolism. We performed this study on 60 healthy Nepalese women who had been using DMPA for more than 2 yr and age- and weight-matched control subjects who were not using hormonal contraceptives. Fasting blood samples were collected from the subjects for the estimation of total cholesterol (TC) and triglyceride (TG) levels, and the levels of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were estimated using the Friedewald's equation. TC and LDL-C levels in DMPA users were significantly higher than those in non-users. Our study concluded that DMPA use induces lipid metabolism changes that can increase the risk of cardiovascular diseases.

Conocimientos, actitudes y aceptación de los efectos secundarios del acetato de medroxiprogesterona en usuarias de un servicio de planificación familiar de Lima, 2005 / Knowledge, attitudes and acceptance of the secondary effects of medroxiprogesterone acetate among users of a family planning service. Lima, 2005

Objetivo: Determinar la asociación que existe entre los conocimientos, actitudes y la aceptación a efectos secundarios en usuarias del acetato de medroxiprogesterona como método anticonceptivo. Métodos: Estudio observacional transversal desarrollado en el Servicio de Planificación Familiar del Hospital Nacional Arzobispo Loayza (HNAL) en enero del 2005. La población estuvo conformada por 125 usuarias de las cuales se entrevistó a 93 que cumplieron con los criterios de inclusión, las cuales acudieron a su cita o en demanda del método. Se utilizó una entrevista estructurada con preguntas de tipo cerrada. La información fue trasladada y procesada en el programa estadístico de SPSS, utilizándose estadísticos descriptivos porcentajes y tablas de frecuencias; para establecer la correlación se uso el coeficiente de correlación de rangos de Spearman. Resultados: En su mayoría las usuarias tienen conocimientos adecuados sobre los efectos secundarios, signos de alarma y forma de uso, no siendo así como el mecanismo de acción. La amenorrea y el sangrado en goteo son los efectos secundarios menos aceptados por las usuarias. Se encontró correlación positiva entre las actitudes de la usuaria hacia el método y la aceptación a sus efectos secundarios, y que no existe correlación entre los conocimientos de la usuaria sobre el método y la aceptación a efectos secundarios. Conclusión: Las usuarias que tienen una actitud positiva al Acetato de Medroxiprogesterona como anticonceptivo tienen una mejor aceptación a sus efectos secundarios. No se encontró evidencia de asociación en este estudio entre los conocimientos y la aceptación a los efectos secundarios.

Aims: To determine the association between knowledge, attitudes and acceptance of side effects in users of medroxyprogesterone acetate as a contraceptive method. Methods: cross-sectional study carried out in the Family Planning Service of the Hospital Nacional Arzobispo Loayza (HNAL) in January 2005. Sample consisted of 125 users of which 93 were interviewed who met the inclusion criteria. Participants came to their appointment or on demand of a birth control method. We used a structured interview with closed-type questions. Information was transmitted and processed in the statistical program SPSS, using descriptive statistics as percentages and frequency tables. To establish the correlation we calculated the Spearman rank correlation coefficient. Results: most users have adequate knowledge about side effects, warning signs and use of the birth control method, it was not the case of the mechanism of action. Amenorrhea and small vaginal bleeding were the less acceptable side effects. A positive correlation between user attitudes towards the method and the acceptance of its side effects was found, and no correlation between knowledge of the user about the method and the acceptance of its side effects. Conclusions: Clients who have a positive attitude towards medroxyprogesterone acetate as a birth control method have a better acceptance of its side effects. We did not found evidence of association in this study between knowledge and acceptance of side effects.

Assessment of DNA nucleo base oxidation and antioxidant defense in postmenopausal women under hormone replacement therapy.

Background and Objective: The aim of the present study was to evaluate oxidative stress byinvesting oxidatively damaged DNA AS Formamidopyrimidine DNA glycosylase (Fpg) -sensitive sites, glutathione peroxidase (GPx), superoxide dismutase (SOD) activities reduced glutathione (GSH) level and nitrite level as satble end product of in women receiving hormone replacement therapy (HRT). Materials and Methods: 127 healthy postmenopausal women receiving HRT and 25 healthy control postmenopausal women were included in this study. Women receiving HRT, comprised surgical menopausal women who underwent surgery for benign conditionsand received conjugated equine estrogen, 0.625 mg/day for 1year (group 1), 5 years (group 2) and more than 10 years (group 3), spontaneous postmenopausal women received conjugated equine estrogen, 0.625 (Premarin) mg/day and medroxyprogesterone acetate, 2.5 mg/day (Premelle) for 1 year (group 4), 5 years (group 5) and more than 5 years (group 6).We investigated in the present study the effects of HRT on nitrite level and GSH level, activities of SOD and GPx and oxidative damage to DNA by comet assays by measuring levels of Fpg-sensitive sites. Results: Although no significant differences were found in the SOD activities, in total group receiving HRT, increased DNA oxidation (P<0.001) together with an increased GPx activity (P<0.001) and nitrite level (P<0.001) as well as a decreased GSH level (P < 0.05) as compared with controls were observed. Conclusion: Estrogen alone or oestrogen in combination with progesterone and duration of use did not significantly alter the results. We evaluated that caused oxidative stress by investigating oxidative DNA damage as Fp-sensitive sites and GSH.NO levels in women receiving HRT.

Body weight and bleeding pattern changes in women using DMPA-SC

To determine the 1-year efficacy of contraception, changes in bleeding pattern and weight with the use of Depot medroxyprogesterone acetate-subcutaneous injected subcutaneously once every 3 months. Descriptive case-series. Gynaecology and Obstetrics Unit, Holy Family Hospital, Rawalpindi, from March 2003 to June 2004. Twenty five patients were selected by purposive sampling and followed up in Holy Family Hospital, Gynaecology and Obstetric Unit for a one-year period using DMPA-SC every three months. Hospital Ethical Committee permission was obtained prior to commencement of the study. Informed written consent was taken. Body weight was measured at baseline and every 3 months thereafter. Bleeding analysis in terms of blood flow and severity of bleeding was also done at 3 months interval using a 5-point scale. DMPA-SC showed 100% efficacy in preventing pregnancy in the 25 patients who were followed up. Mean and SD of age was 34.24 +/- 3.57 years. Mean and SD of weight was 63.44 +/- 13.81 kg. There was a mean weight gain of 0.1 kg at visit 1-3 [first 3 months] and an average weight gain of 1.036 kg at the end of the year. There was a trend towards amenorrhea with 56% of the patients included in the category of bleeding less than usual at the end of treatment period. DMPA-SC can be used in women desiring reversible contraception with unremarkable weight gain and overall bleeding pattern leading towards amenorrhea

Effect of depot medroxyprogesterone [DMPA] on body weight and serum lipid profile in adult female rats

Depo Provera [Medroxyprogesterone Acetate, DMPA] is a long-acting, injectable progesterone derivative contraceptive that is currently used by 30 million women in 90 countries, including Egypt, United States and Canada. DMPA classified as sex hormone binding globulin [SHBG]. The objective of this study was to investigate body weight and serum lipid profile following treatment of rats with the injectable contraceptive depot medroxyprogesterone acetate, [Depo Provera; DMPA]. Adult female rats [Rattus norvigcus] were treated with a single dose of DMPA that is comparable to the weight-corrected dose in humans [2.7 mg/rat or 5.4 mg/rat] and sacrificed on day ten or fifteen post treatment. Body weights were recorded and sera from both treated and control groups studied for lipid profile using a colorometric method. Treating animals with 2.7 mg/rat or 5.4 mg/rat of DMPA for 10 and 15 days led to a dose-related increase in the body weights [maximum 24.77%]. There was increase in total lipids [TL], triglycerides [TG], total cholesterol [TC] as well as low density-lipoprotein cholesterol [LDL-C] and very low density lipoprotein [VLDL-C]. On the other hand, a marked decrease was found in high density-lipoprotein cholesterol [HDL-C] in the DMPA-treated groups. Statistical analysis indicated that these changes were significant [p < 0.01] in all treated groups compared to control ones. We concluded that, this preliminary study indicates a long-term atherogenic role for DMPA

Cystic endometrial hyperplasia and endometritis in a dog following prolonged treatment of medroxyprogesterone acetate

An 8-year-old female Yorkshire Terrier was presented for investigation of reduced appetite, and occasional vomiting. She has been treated with medroxyprogesterone acetate (MPA) from past 3 year-old age for contraception. Abdominal sonography showed abnormal enlargement of uterus, and ovariohysterectomy was performed. Main gross findings of uterus were enlarged lesions in two areas of the left horn, which had thickened wall and yellowish sticky material in the lumen. Histopathologically, cystic endometrial hyperplasia (CEH) and endometritis were present in the thickened area. In this case, CEH and endometritis may be attributed to prolonged treatment of MPA. It was concluded that further study is needed to clarify the association of MPA treatment with age, its pathogenesis and abnormal uterine changes in dogs.

Contraception continuation rates and reasons for discontinuation in Zahedan, Islamic Republic of Iran

We evaluated contraception continuation rates and discontinuation reasons in Zahedan among 1741 women from 1998-2000. By Kaplan-Meier technique continuation rates were 92% for low dose combined hormonal oral contraceptives [OC], 86% for a levonorgestrel-releasing implant, 82% for intrauterine devices [IUD] and 53% for medroxyprogesterone acetate at the first year. After 3 years, continuation was 78% for levonorgestrel implant, 70% for OC, 60% for IUD and 44% for medroxyprogesterone acetate. The commonest reason for discontinuing OC and medroxyprogesterone acetate was changing method; for IUD and levonorgestrel-releasing implant, the commonest reason was side-effects. By Cox regression model, continuation rate and contraceptive type were significantly related to health centre

Effect of two injectable contraceptive drugs on the ovary and endometrium of the adult female albino rat: histological and immuno-histochemical study

This study was carried out to determine the histological and immuno-histochemical changes induced in the ovary and endometrium following injection and stoppage of Depot-Provera and Mesigyna, injectable contraceptive drugs. In addition to determine the relation between the proliferative activity of the endometrium and estrogen receptors content of the ovary. Thirty three adult female albino rats were used in this work, which were divided into three groups; the first group [Ia,Ib,Ic] as control. The second group [IIa and IIb] was injected twice with Depot-Provera once/3 weeks then sacrificed after one day and six weeks respectively from the last injection. The third group [IIIa and IIIb], was injected six times with Mesigyna once/week then sacrificed after one day and two weeks respectively from the last injection. The ovaries and uteri of all rats were taken and stained with H and E stain and immuno-histochemical stains. The H and E stained sections of the ovaries in groups IIa and IIIa revealed atresia and degeneration of the growing follicles with few corpora lutea and some cystic dilatations. In group IIb, they still showed some degenerated follicles but in IIIb, some growing follicles and fresh corpora lutea were observed. The endometria of group IIa revealed few, small and quiescent endometrial glands, which were embedded in a highly vascular and edematous stroma.While group IIIa revealed that the endometrial surface was lined partially by pseudostratified epithelial cells. The endometrial glands appeared tubular dilated and embedded in a moderately dense stroma. In group IIb they still showed small and few endometrial glands embedded in a less edematous stroma. However, in group IIIb, the endometrial histology returned to control pattern. The immunohistochemical [SP1] stained sections of the ovaries of group IIa revealed marked decrease of estrogen receptors content, which increased in group IIb, but still less than control level. On contrary, it was apparently increased in group IIIa and then returned to control level in group IIIb. The [Ki-67] stained sections of the endometria of group IIa revealed reduction in the proliferative activity, which still remained lower than control level in group IIb. However, in group IIIa the proliferative activity was increased but returned to the control level in group IIIb. In conclusion, this study clarified that Mesigyna induced less suppressive effects on the ovary and endometrium with an earlier return of their activity than with Depot-Provera. Also, there was an evident direct relationship between the proliferative activity of the endometrium and estrogen receptors content of the ovary

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

Objetivos: acompanhar a incidência de efeitos colaterais e aceitabilidade (taxa de continuidade) do acetato de medroxiprogesterona de depósito (DMPA) como contraceptivo injetável trimestral em adolescentes do nosso meio. Método: quarenta adolescentes (70 por cento) iniciaram o uso do DMPA, tendo sido acompanhadas por uma média de 14,2 meses. As queixas espontâneas, as alteraçöes menstruais, dados do exame físico e exames laboratoriais foram coletados e analisados pelos testes de Wilcoxon e McNemar. Resultados: as queixas mais freqüentes foram cólica (16,6 por cento) e cefaléia (15,2 por cento). Os padröes menstruais predominantes foram o spotting e a oligomenorréia. Näo foi observada variaçäo significativa da pressäo arterial sistólica durante o acompanhamento, mas houve uma ligeira queda nos níveis da pressäo arterial diastólica, no limite da significância. Näo houve alteraçöes significativas da glicemia de jejum, e foi observada uma tendência ao aumento da taxa de hemoglobina. O ganho do 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. Conclusäo: o acetato de medroxiprogesterona de depósito mostrou-se um contraceptivo satisfatório para as adolescentes.

Efecto del contraceptivo inyectable Depo-Provera sobre el metabolismo de la glucosa / Effect of the depo-provera injectable contraceptive on the glucose metabolism

Se estudió el efecto del contraceptivo hormonal inyectable depo-provera sobre el metabolismo de la glucosa en una muestra de 21 mujeres; se evaluó antes, a los 3 meses y a los 9 después de iniciado el tratamiento con el contraceptivo, se realizó en cada momento, una prueba de tolerancia a la glucosa endovenosa (PTG-E) con múltiples extracciones. Se calcularon los siguientes indicadores para evaluar el metabolismo de la glucosa: área total bajo la curva de glucemia, área total incremental bajo la curva de glucemia, área inicial de glucemia, área inicial incremental de glucemia, área total bajo la curva de insulinemia, área total incremental bajo la curva de insulinemia, área inicial de insulinemia, área inicial incremental de insulinemia, índice insulinogénico inicial, índice insulinogénico total, y coeficiente Kg (pendiente de los valores del logaritmo neperiano de la glucemia desde los 10 min hasta los 19 min). Se observaron alteraciones en el metabolismo de la glucosa tanto a los 3 como a los 9 meses después de iniciado el tratamiento, dado por un incremento de la respuesta insulinosecretora y un estado de insulinorresistencia, aunque en ninguno de los casos las alteraciones fueron clínicamente importantes(AU)

The effect of the depo-provera injectable hormonal contraceptive on glucose metabolism was studied in a sample of 21 women. It was first evaluated at the 3 months and then 9 months after the beginning of the treatment. An endovenous glucose tolerance test was made every time with multiple extractions. The following indicators were calculated to evaluate glucose metabolism: total area under the curve of glucaemia, total incremental area under the curve of glucaemia, initial area of glucaemia , initial incremental area of glucaemia, total area of insulinaemia under the curve, initial area of insulinaemia, initial incremental area of insulinaemia, initial insulinogenic index, total insulinogenic index and Kg coefficient (pending on the values of the napierian logarithm of glucaemia from 10 min to 19 min). Alterations in the glucose metabolism were observed on the 3rd and 9th month after the beginning of the treatment due to an increase of the insulinosecretory response and to a state of insulin resistance, although the alterations were not clinically important in any of the cases(AU)

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