[Equine estrogens vs. esterified estrogens in the climacteric and menopause. The controversy arrives in Mexico]. / Estrógenos equinos vs. estrógenos esterificados en el climaterio y la menopausia. La controversia llega a México.

It exists controversies about if the effects and benefits of the esterified estrogens could be similar to those informed for equines, because its chemical composition and bioavailability are different. Esterified estrogens has not delta 8,9 dehydroestrone, and its absorption and level of maximum plasmatic concentrations are reached very fast. In United States of America and another countries, esterified estrogens has been marketed and using for treatment of climacteric syndrome and prevention of postmenopausal osteoporosis, based on the pharmacopoiea of that country, but the Food and Drug administration (FDA) has not yet authorized up today, a generic version of conjugated estrogens. In Instituto Mexicano del Seguro Social (IMSS) and another institutions of health sector in Mexico, starting in year 2000, it has been used esterified estrogens for medical treatment of climacteric and menopausal conditions. For this reason, in this paper we revised the most recent information about pharmacology, chemical composition, clinical use and costs of the conjugated estrogens with the purpose to guide the decisions to purchase this kind of drugs in Mexican heath institutions.

[Experience and knowledge about climateric and menopause in women in Mexico City]. / Experiencias y conocimientos sobre climaterio y menopausia en mujeres de la ciudad de México.

OBJECTIVE: To know the experiences and knowledge about climateric and menopause in a group of women covered by Instituto Mexicano del Seguro Social (IMSS). The purpose was to contribute for planning some strategies to increase seeking for medical care at these periods of life. MATERIAL AND METHODS: Descriptive survey study in a randomized sample of women aged 50-59 years, currently users of medical services in family medicine system of IMSS en Mexico City, with a confidence interval of 95%. RESULTS: Mean age at menopause was 47.8 years. Most frequent climateric symptoms were: hot flushes (70.9%), depression (60.2%), insomnia (53.5%) and menstrual disturbances (37.8%). 51.1% of women seeked medical care due to climateric symptoms but only 12.1% received treatment, majority hormonals (81.6%). Past users were 14.9% and they received hormones too in 87.8%. In this survey, 83.8% of women had some knowledge about main symptoms of climateric and 90.1% knew about osteoporosis but only 37.2% had some knowledge about cardiovascular risk after menopause. The prevention of osteoporosis and coronary disease was associated with calcium and exercise; only in 1% with use of hormonals. CONCLUSIONS: It exists an acceptable level of information about climateric syndrome and postmenopausal osteoporosis in these women, but it is low for risk of cardiovascular disease. Probably, their information is got from the mass media communication and did not for the activities of medical institutions in health education.

[Indications and justification of cesarean sections at the Instituto Mexicano del Seguro Social]. / Indicaciones y justificación de las cesáreas en el Instituto Mexicano del Seguro Social.

OBJECTIVE: In view of the high frequency rates of cesarean section at the Instituto Mexicano del Seguro Social (IMSS), we carried out a study to know main causes and its justification. MATERIAL AND METHOD: Retrospective study in a randomized national sample of clinical records in 3,232 cesarean cases between June 1997 and June 1999. RESULTS: The most frequent indications were cephalopelvic disproportion (29.6%), one previous section (20.9%), acute fetal distress (14.1%), iterative section (11.9%), and premature rupture of amniotic membranes (10.7%). In cephalopelvic disproportion cases, mean weight of newborns was 3,430 g., 70.6% of patients had irregular uterine contractility, and 21.7% received oxytocin; 78.2% had integrity of membranes and 4 cm or less in cervical dilation. In previous section and cephalopelvic disproportion the mean weight of newborns was 3,425 g; 81.7% did not have regular contractility and, 4.8 received oxytocin. In sections due to acute fetal distress, 94.9% had an Apgar in 8 or more at 5 minutes after delivery. CONCLUSION: The cesarean indications at the IMSS were similar to those are informed most to date in Mexico and throughout the world, but we did not find justification most of cases in this study.

[Injectable contraception using depot progestagens]. / Anticoncepción inyectable con progestágenos de depósito.

PIP: After 20 years of clinical experience, injectable hormonal contraceptives such as norethisterone enanthate (NET) and medroxyprogesterone acetate (MPA) remain one of the most controversial methods currently used for temporary control of fertility in women. Since December 1980 this controversy has been accentuated in Mexico with issuing of regulations by the Secretary of Health and Welfare which initially did not permit promotion of long-acting injectable hormones for contraception purposes, and later, in June 1981, a reconsideration which exclusively authorized use of NET as an injectable contraceptive. Undeniably these official measures and the scientific information, occasionally contradictory, have created confusion about the indications and risks of using these formulations in clinical work. This paper presents an anlysis of the basic pharmacological aspects of long-acting contraceptive progestagens, potential risks for side effects, and some clinical rules for safe use. The authors conclude that injectable contraceptives will continue holding a definite place among hormonal methods of temporary fertility control, particularly with the advent of new administration schemes for NET which have elevated its contraceptive efficacy without appreciably increasing complications. The more rapid metabolism of NET, manifested in the absence of significant effects on body weight, less alteration of the menstrual cycle, and more rapid return of fertility after discontinuation, has considerably increased its popularity, and the possibility exists that with time and an increase in clinical experience, it may replace MPA as the injectable contraceptive of choice. Nevertheless, while investigative studies have not clearly defined the possibilities of potential risk of using these contraceptives, its clinical use must be governed by appropriate selection and careful follow-up of patients.^ieng

[Use and effectiveness of norethisterone enanthate for family planning in a rural area]. / Uso y efectividad del enantato de noretisterona para la planificación familiar en el área rural.

PIP: The objective of this study was to analyze the acceptability, effectiveness, and continuation of long-acting progestagens in certain sectors of the population where its advantages are more obvious by virtue of certain socioeconomic, cultural, and geographic characteristics, and by lack of availability of family planning services, as in rural areas and urban marginal zones. The study was performed using females of reproductive age residing in rural areas of the Mexican States of Hidalgo, Puebla, and Yucatan between July 1981 and September 1982. Originally the investigation included a total of 462 women, of whom 94 were lost to follow-up, leaving a total of 368 patients (79.6%) with effective follow-up. The contraceptive used was 19-Nor progestagen, norethisterone enanthate (NET), in 200 mg doses administered intramuscularly. The 1st dose was applied between the 1st to the 5th day of the menstrual cycle and each 60 calendar days thereafter. Of a total of 94 discontinuations, 2/3 occurred during the 1st 6 months of the study. The final discontinuation rate was 14.46%. The studied population showed a continuation rate of 85.54% after 12 months of use. Observing rates by reasons for discontinuation, the principal causes in descending order were nonmedical reasons, amenorrhea, pregnancy, bleeding and other secondary effects. The greatest number of discontinuations, considering each particular reason, occurred predominantly during the 1st 6 months of the study. Distribution of users by age group show that more than 2/3 (71.8%) were between 20 and 34 years old. Distribution by number of previous pregnancies show 56.5% with 5 or more gestations. To analyze behavior of menstrual cycles, "cycles" were defined as period of 30 calendar days. Under this concept, more than 2/3 (70.9%) of the users had from 1 to 7 days of bleeding per cycle. On the basis of the results of the study, it is possible to conclude the following: 1) Continuation of NET use is greater than that observed with other long-lasting progestagens. This seems to be especially so when employed in areas where limitations exist for the utilization of other contraceptive means. 2) Contraceptive effectiveness is greater when administration is scheduled at 60 day intervals rather than longer intervals. 3) Unlike other long-acting progestagens, NET conserves the normal menstrual pattern in the majority of users, which favorably influences its continuation.^ieng

Uso y efectividad del enantato de noretisterona para la planificacion familiar en el area rural. / Use and efficacy of norethisterone enanthate for family planning in rural area

Se presentan los resultados de un estudio efectuado en 368 mujeres residentes en areas rurales de Mexico, que utilizaron enantato de noretisterona como anticonceptivo inyectable de intervalo. El esquema de administracion fue de 200mg por via intramuscular cada 60 dias. Se encontro una descontinuacion de 14.46 a un ano de uso, siendo las razones principales las no medicas y en segundo lugar, los trastornos del ciclo. La tasa de embarazos resulto de 2.09 por ciento. Tambien se observo que el 70.9 por ciento de las usuarias presentaron 1 a 7 dias de sangrado por mes, es decir, que mostraron una regularidad considerable en sus ciclos. Se comentan asimismo las posibles razones de la alta continuidad observada con el metodo y la baja incidencia de trastornos menstruales

Anticoncepcion inyectable con progestagenos de deposito. / Injectable contraceptives with long-acting progestogens

Los anticonceptivos inyectables a base de progestagenos de deposito, vigentes en la actualidad para uso clinico son el enantato de noretisterona (ENE) y el acetato de medroxiprogesterona (AMP). En Mexico, solo esta recomendado el empleo de ENE, que por su metabolismo mas rapido, produce menores efectos secundarios y un retorno mas rapido de la fertilidad al descontinuarlo.Se presenta un analisis de los aspectos farmacologicos basicos de los progestagenos de deposito, de sus efectos secundarios y riesgos potenciales, asi como algunas normas clinicas para su empleo

[Acceptability of medroxyprogesterone acetate among medical and paramedical personnel in family planning]. / Aceptabilidad del acetato de medroxiprogesterona entre personal médico y paramédico en planificación familiar.

PIP: Depot medroxyprogesterone acetate (DMPA) generally injected in doses of 150 mg every 3 months, is offered in the official family planning program of Mexico. The study purpose was to assess the impact of attitudes toward DMPA of medical and paramedical family planning workers on the frequency of prescription and acceptance of DMPA in the national family planning program. A 21-item multiple choice mail questionnaire was returned by 644 persons including 279 physicians, 257 nurses, and 104 social workers from Mexico City and 24 of the 31 states, a response rate of 55.6%. 338 of the respondents worked in health centers, 274 had worked in family planning for less than 1 year, and 427 were female. 365 had previous experience with DMPA. 458 knew the correct quarterly dose. Only 66 persons (10.8%) frequently prescribed DMPA, while 373 (61.1%) occasionally prescribed it and 169 (27.7%) never did so. 582 persons knew of at least 2 other injectable contraceptives. Among side effects, 423 persons mentioned frequent amenorrhea, 267 frequent bleeding, and 329 a reduction of future fertility. 203 mentioned that it did not affect lactation. 361 noted that it has high contraceptive efficacy. 439 considered administration of DMPA simple and 235 thought it was a good contraceptive. Asked what type of injectable contraceptive they preferred, 148 selected a combined monthly injection, 125 selected a progestogen every 84 days, and 115 selected DMPA. 416 considered their information on DMPA to have come from scientific sources. Medical journals were cited by 156, training courses by 271, and commercial promotions by pharmaceutical companies by 236. 612 persons (97.0%) felt that more training on DMPA use should be provided for family planning personnel, and 594 (94.7%) felt that users should receive more information. Discrepancies in the knowledge of DMPA among family planning workers indicate the need for improved training of new family planning workers and for continuing education of experienced workers.^ieng

Aceptabilidad del aletato de medroxiprogesterona entre personal medico y paramedico en planificacion familiar. / Acceptability of the medroxyprogesterone acetate use among medical and allied health personnel in family planning

Es indiscutible que en la evaluacion de cualquier metodo anticonceptivo, es importante conocer no solo la opinion de las usuarias, sino tambien del personal encargado de aplicarlo en los programas de planificacion familiar, por lo que se planteo este estudio en el que se investigo la aceptualidad del uso de acetato de medroxiprogesterona, recomendado por dicho personal, encontrandose lo siguiente: Hasta el momento actual continua siendo objeto de controversia, en un alto porcentaje de los entrevistados son insuficientes los conocimientos sobre efectividad, efectos secundarios y otros aspectos, por lo que se concluye que son necesarios la capacitacion adecuada del personal de nuevo ingreso a los programas de planificacion familiar, asi como el establecimiento de sistemas de educacion continua en los mismos

[Acceptability of medroxyprogesterone acetate in rural areas of Mexico]. / Aceptabilidad del acetato de medroxiprogesterona en las áreas rurales de méxico.

PIP: 361 retrospective surveys were carried out among users of medroxyprogesterone acetate (MPA) given in a trimestral regimen of 150 mg/dose in rural areas of 3 Mexican states. Gynecology-obstetric antecedents, previous experience with oral contraceptives (OCs), effects of injections on the menstrual cycle, causes of method suspension, and opinion concerning administration of medication were analyzed. 78.6% of the patients were multigravidae with 4 or more pregnancies; 39.1% were former users of OCs, and 23.4% had stopped taking them because of side effects. The side effects of MPA on the menstrual cycle were: amenorrhea (19.8%); hemorrhage/cycle of 10-30 days in 14.7%; and hemorrhage/cycle of 30 or more days in 11.6%. Only 14.7% of users stopped the injections and of these, 80.3% did so due to menstrual cycle disorders. 99.7% of the users thought the method was comfortable as a family planning procedure. (author's)^ieng