Extended regimens of the contraceptive vaginal ring versus hormonal oral contraceptives: effects on lipid metabolism.

BACKGROUND: Combined oral contraceptives used in an extended regimen have been studied because of their potential benefits; however, there have been few publications on extended regimens of contraceptive vaginal rings. The aim of this study was to assess the effects of these two extended regimens on the lipid metabolism of women using these contraceptive methods during 1 year. STUDY DESIGN: This prospective study enrolled 150 women: 75 used a vaginal contraceptive ring (11.7 mg etonogestrel and 2.7 mg ethinyl estradiol), and 75 used oral contraceptives (30 mcg ethinyl estradiol and 150 mg desogestrel). Both groups used their respective method for 84 days followed by a 7-day pause during 1 year. At baseline and every 3 months during the study period, blood was collected to assess total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and apolipoprotein (apo) A-I and B. The analysis of variance test was used to analyze differences in the results of these exams over time. RESULTS: A total of 62 vaginal ring and 61 oral contraceptive users completed the study. There were no significant differences in the discontinuation rate, mean total cholesterol and fraction levels, apo B concentration or apo A-I/apo B ratio. Vaginal ring users had significantly higher apo A-1 levels than oral contraceptive users. CONCLUSION: Despite the vaginal route of administration, the steroids released by the ring had the same effects on the lipid metabolism and lipoprotein levels typically seen with ethinyl estradiol given either by oral or parenteral routes.

Extended regimens of the combined contraceptive vaginal ring containing etonogestrel and ethinyl estradiol: effects on lipid metabolism.

BACKGROUND: Oral contraceptives used for extended periods of time have been studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate modifications in the lipid profile of women using the vaginal ring continuously over a 1-year period. STUDY DESIGN: This prospective cohort enrolled 75 women (18-37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. At baseline and every 3 months during the 1-year study period, blood was collected to assess cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides and apolipoproteins A-I and B. The ANOVA test was used to analyze differences in the results of these exams over time. RESULTS: After 1 year of continuous contraceptive use, there was a significant increase in triglycerides as well as in total and HDL-C levels. There was a nonsignificant decrease in the mean concentration of LDL-C during the study period. Apolipoprotein A-I increased and apolipoprotein B decreased, but the apolipoprotein A-I/apolipoprotein B ratio did not change significantly. CONCLUSION: The combined contraceptive vaginal ring used on an extended regimen causes changes in the lipid profile metabolism of users. Despite the vaginal route of administration, the steroids released by the ring caused significant changes in lipids and lipoproteins, which were typical of those seen with ethinyl estradiol given either orally or parenterally.

Extended regimens of the contraceptive vaginal ring: evaluation of clinical aspects.

BACKGROUND: Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate the clinical symptoms, body weight and blood pressure changes in women using the vaginal ring continuously over a 1-year period. STUDY DESIGN: This prospective cohort evaluated clinical aspects (dysmenorrhea, headache, breast tenderness, leg pain and irritability), body weight and blood pressure changes in 75 women (18-37 years of age) using a vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily, over a continuous period of 84 days, followed by a 7-day ring-free interval, during 1 year. The chi-square, Wilcoxon and paired t tests were used to analyze differences in the outcomes of interest. RESULTS: Compared to pre-enrollment status, at the end of the study period, the patients reported significantly less dysmenorrhea and irritability, a nonsignificant decrease in breast tenderness, leg pain and headaches. Blood pressure measurements remained unchanged. Although weight and body mass index increased significantly among users, they remained within the expected biological variation range. CONCLUSION: The vaginal ring used on an extended regimen is a well-tolerated contraceptive method and also offers noncontraceptive benefits.

Extended regimens of the vaginal contraceptive ring: cycle control.

BACKGROUND: Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimen of vaginal rings. The aim of this study was to compare the bleeding patterns of women using extended regimens of the vaginal ring or oral contraceptives. STUDY DESIGN: Prospective cohort involving 150 women: 75 used vaginal rings that release 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily, and 75 took oral contraceptives containing ethinyl estradiol 0.3 mcg and desogestrel 150 mcg. Both groups used their respective contraceptive method over continuous periods of 84 days, followed by a 7-day pause, during 1 year. RESULTS: The total number of scheduled bleeding and spotting days decreased significantly during the 1-year period of the study for both methods (p=.001), and this decrease was significantly higher for oral contraceptive users. Similarly, during the study period, there was a significant reduction in the total number of unscheduled bleeding and spotting days for both methods (p=.01), but this decrease was significantly higher among vaginal ring users (p=.003). CONCLUSION: Vaginal ring used on an extended regimen is a contraceptive method that offers good cycle control.

Métodos anticoncepcionais hormonais / Hormonal contraception methods

A orientação e a utilização da anticoncepção abrangem um grande período de vida da mulher, que vai do menacme à menopausa, atingindo vários segmentos de faixa etária. Nenhum método poderá satisfazer as necessidades de todas as mulheres nas diversas etapas de sua vida reprodutiva, pois variam quanto a: eficácia, efeitos secundários, formas de uso e custo. Assim, o aconselhamento sobre todos os métodos é indispensável para que as pessoas tomem decisões adequadas. Nos últimos anos ocorreram grandes avanços no conhecimento científico, em relação ao desenvolvimento e pesquisa de novos métodos contraceptivos hormonais. A Organização Mundial de Saúde, no sentido de facilitar e auxiliar os orientadores e prescritores de anticoncepção, elaborou uma classificação para adequar o uso dos métodos contraceptivos hormonais na presença de algumas condições (idade, paridade) ou de intercorrências clínicas, cirúrgicas ou ginecológicas. Os riscos e benefícios da utilização dos métodos contraceptivos foram avaliados de forma criteriosa, podendo auxiliar a opção mais adequada de contracepção.

Contraceptive counseling and its use are part of women's lives from menarche to menopause, thus spanning through a woman's lifetime. Since each method has a different profile in terms of effectiveness, collateral effects, usage and costs, no single contraceptive is expected to meet the demands of every woman throughout the various phases of her reproductive life. Therefore, contraceptive counseling is essential in assiting women make appropriate choices. In the last years there have been important scientific advances in the field of contraceptive research and development. In this context, the World Health Organization has created a classification that is useful to the people in charge of counseling and prescribing contraceptive methods. This classification takes into consideration some demographic variables (age, parity) as well as clinical, surgical and gynecological conditions. The risks and benefits of each contraceptive method have been carefully assessed, thus allowing a judicious choice to be made.

Bleeding patterns of women using extended regimens of the contraceptive vaginal ring.

INTRODUCTION: This prospective observational study evaluated the bleeding patterns of women using a vaginal ring releasing 120 microg of etonogestrel and 15 microg of ethinyl estradiol daily, over a continuous period of 84 days followed by 7 ring-free days. METHODS: The study enrolled 75 volunteers aged 18 to 37 years. Sixty-two (82.8%) recorded their menstrual cycles during 1 year. RESULTS: At the end of the study, 85.5% had adequate menstrual patterns (two to four bleeding episodes, none lasting 10 days or more, with a range of bleeding-free intervals not exceeding 17 days), 9.7% had infrequent bleeding, 1.6% reported prolonged bleeding episodes, 1.6% had frequent bleeding and 1.6% had irregular bleeding. CONCLUSION: Only 5 of the initial 75 patients discontinued the method due to bleeding. Among these 75 women, dissatisfaction with bleeding patterns was not a frequent reason given for discontinuation of the contraceptive vaginal ring.

Achados laparoscópicos na infertilidade / Infertility and laparoscopic finding

O objetivo deste trabalho é rever retropectivamente os achados laparoscópicos em mulheres infertéis. Entre 1990 e 1997 foram realizadas 115 laparoscopias em mulheres com queixa de infertilidade, seguidas no ambulatório de Esterelidade da Faculdade de Medicina de Londrina/UEL. Deste total, 100 mulheres foram analisadas quanto a idade, paridade, tipos de partos e abortos anteriores, presença de prenhez ectópica anteiror ao procedimento laparóscopico, história prévia de doença inflamatória pélvica (DIP) e dismenorréia. A seguir as pacientes foram avaliadas quanto ao achado laparoscópio, sendo os mais freqüentes endometriose (54 por cento) e aderências pélvicas (49 por cento). Ainda foram encontradas 22 pacientes com laqueadura tubária prévia e nove pacientes com mioma. Deste universo de pacientes 39 tiveram cromotubagens positivas, 34 cromotubagens negativas, 20 cromotubagens positiva uniteralmente e sete inconclusivas