Understanding Progestins: From Basics to Clinical Applicability.

Progestin is a term used to describe a synthetic progestogen. The activity and potency of synthetic progestins are mostly evaluated via parameters associated with their endometrial effects, which are related to their interactions with progesterone, estrogen, androgen, glucocorticoid, and mineralocorticoid receptors. The chemical structure of progestins is the key to understanding their interactions with these receptors and predicting the other effects associated with these drugs. Due to their endometrial effect, progestins are used for different gynecological conditions, such as endometriosis, contraception, hormonal replacement therapy, and artificial reproduction techniques. This review is focused on improving our knowledge of progestins (from their history and biochemical effects related to their chemical structures to clinical applications in gynecological conditions) in order to improve clinical practice.

[Use of contraception with only progestogens in primary care: Study GESTAGAP]. / Uso de la anticoncepción con solo gestágenos en atención primaria: estudio GESTAGAP.

AIM: To estimate the prevalence of use of progestin-only contraceptive among women who request reversible contraception in Primary Care (PC). DESIGN: Multicentre cross-sectional study. SETTING: Primary Care Health Care Centres (Madrid). PARTICIPANTS: Women aged 16-50 years old, users of reversible contraception, who speak Spanish, and had attended the Primary Care Centre in the last year. MAIN MEASUREMENTS: Primary outcome: contraceptive method used: Contraception with progestins-only (yes/no). Age, parity, country of origin, type of contraceptive method used, reason for choice, source of information, satisfaction with the contraceptive method. Telephone survey. RESULTS: A total of 417 women were interviewed. The median age was 30.3years (SD: 7.7). Spanish 69%, and 82% of participants had secondary or university studies. More than half (57%) were nulliparous. The type of contraceptive used included: progestins only: 14%, combined hormonal contraceptive: 74%, copper IUD: 2%, and condom 10%. The prevalence of use of "progestins-only" was 13.9% (95%CI: 10.6-17.2). Medroxyprogesterone acetate injection was the most progestin-only method used (4.6%), desogestrel oral pill (4.1%), IUD-levonorgestrel IUD (3.9%), and etonogestrel subdermal implant (1.9%). The family doctor was the prescriber in 71% of the women. Satisfaction: high (range 9-10). Using only progestogens was associated with older age, being non-Spanish, breastfeeding, and having a medical contraindication for combined contraception (P<0.05). CONCLUSIONS: The prevalence of use for progestins was 14%, satisfaction was very high for all contraceptive methods. The user profile for the only progestins-only corresponds to older, and non-Spanish women with conditions such as breastfeeding or contraindications for other contraceptives.

Evaluación de tecnología sanitaria: anovulatorios orales combinados congestodeno comparados con los combinados con levonorgestre / Health technology assessment: combined oral contraceptives containing gestodene compared with those containing levonorgestrel

Esta evaluación de tecnología sanitaria compara un nuevo anovulatorio oral combinado con etinil estradiol 20µ más gestodeno 75µ, con el que contiene etinil estradiol 30µ más levonorgestrel 150µ, utilizado hasta ahora en el subsistema de salud pública de la provincia de Neuquén. De acuerdo a las evidencias halladas, en cuanto a equivalencia de eficacia y riesgos de seguridad –principalmente relativas al aumento significativo en el riesgo de presentar trombosis venosa y embolia pulmonar– se recomienda fuertementeno incorporarlo al vademécum provincial.

Retiro temprano del implante subdérmico con etonogestrel en usuarias de un programa de anticoncepción de Tunja - Boyacá, Colombia / Early removal of subdermal implant containing Etonogestrel in users of a contraceptive program from Tunja - Boyacá, Colombia

Introducción: Los implantes subdérmicos proveen alta efectividad anticonceptiva reversible; no obstante, con su empleo ocurren algunos efectos colaterales. Se ha demostrado que algunas mujeres son menos tolerantes a ellos y solicitan tempranamente el retiro. Objetivo: Evaluar factores relacionados con el retiro del implante subdérmico Implanon®, en mujeres usuarias del programa ambulatorio de Planificación Familiar de una institución de Salud ubicada en Tunja. Materiales y métodos: Estudio observacional, de corte transversal analítico. Se revisaron las historias clínicas de 184 usuarias que solicitaron el retiro del implante en el período comprendido entre 2009 y 2012; se registraron las razones aducidas por las pacientes para solicitar el retiro del implante subdérmico, excluyendo el deseo de una nueva gestación y el tiempo de empleo. Resultados: La media de edad fue de 27,8 años; el tiempo mínimo de uso fue 2 meses, con media de 2,7 años (SD=1,7), la principal razón fue cambios en el patrón de sangrado genital (74,5%), seguida de cefalea (71,7%), cambios en el estado de ánimo (57,6%), dolor pélvico 57,1% y dolor de origen venoso 42,9%; la mayoría de efectos se presentan al inicio de la inserción y tienden a desaparecer en el curso de los primeros meses, con excepción de la cefalea y los cambios de peso. Conclusiones: El implante subdérmico es un método anticonceptivo altamente eficaz; es recomendable realizar intervenciones de educación en salud previo a la inserción.

Introduction: Subdermal implants provide high reversible contraceptive effectiveness; however, some side effects occur with their use. It has been shown that some women are less tolerant to them so they ask for an early retirement. Objective: To assess factors related to the removal of the subdermal implant Implanon ® in women who are users of the ambulatory family planning program of a health institution located in Tunja. Materials and methods: An observational, analytical cross-sectional study was made where the medical histories of 184 users who requested the removal of the implant between 2009 and 2012 were reviewed. The reasons given by patients to request the removal of the subdermal implant were registered, excluding the desire for a new pregnancy and the time use. Results: It was found that the average age was of 27,8 years; the minimum time of use was 2 months with average of 2.7 years (SD = 1, 7). The main reason to request the procedure was due to the changes in their period (74.5%), followed by headache (71.7%), changes in mood (57.6%), pelvic pain (57.1%) and pain of venous origin (42.9%). Most effects occur at the beginning of the inclusion and tend to disappear in the course of the first months, except for the headache and weight changes. Conclusions: The subdermal implant is a highly effective method of birth control. It is recommended to make effective health education interventions prior to insertion.