DOCSLIB.ORG

Review of the Role of Medroxyprogesterone Acetate 5 Mg in Hormone Replacement Therapy for Postmenopausal Women

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Review of the Role of Medroxyprogesterone Acetate 5 Mg in Hormone Replacement Therapy for Postmenopausal Women 18th Expert Committee on the Selection and Use of Essential Medicines (21 to 25 March 2011) Section 18: Hormones, other endocrine medicines and contraceptives Section 18.7: Progestogens -- Medroxyprogesterone acetate (Possible deletion) Review of the role of Medroxyprogesterone acetate 5 mg in hormone replacement therapy for postmenopausal women Name of the organization preparing the application School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia 1. Pehlic Marina 2. Sambunjak Dario 3. Stipic Ivica 4. Novak Ribicic Kristijana 5. Strinic Tomislav Acknowledgment We thank Ana Utrobicic for her assisstance in conducting literature search and obtaining the needed articles. ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 1. Pehlic Marina,MD, Research fellow, Department of Medical Biology, School of Medicine, University of Split, Soltanska 2, 21000 Split, CROATIA 2. Sambunjak Dario,MD,PhD, Director, Croatian Branch of the Italian Cochrane Centre, Senior Editor of Croatian Medical Journal, School of Medicine, University of Split, Soltanska 2, 21000 Split 3. Ivica Stipic,MD, Resident doctor, Department of Obstetrics and Gynecology, University Hospital Split, Spinciceva 1, Split, School of Medicine, University of Split, Soltanska 2, 21000 Split 4. Novak Ribicic Kristijana,MD, Resident doctor, Department of Obstetrics and Gynecology, University Hospital Split, Spinciceva 1, 21000 Split 5. Professor Tomislav Strinic, MD,PhD, Specialist in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University Hospital Split, Spinciceva 1, Split, School of Medicine, University of Split, Soltanska 2, 21000 Split 1 The aim of this review is to evaluate safety and efficacy of per os medroxyprogesterone (MPA) in 5mg dosage regimen for hormonal replacement therapy (HRT) by searching all published papers and reports. MPA is currently listed on the 16th WHO Model List of Essential Medicines in group 18.7 Progestogens (http://www.who.int/medicines/publications/essentialmedicines/Updated_sixteenth_adult_list_en.pdf) 1.Introduction 1.a) MPA Medroxyprogesterone acetate or MPA is a progestin, a synthetic variant of the human hormone progesterone. MPA inhibits secretion of pituitary gonadotropins, thereby preventing follicular maturation and ovulation (contraceptive effect); inhibits spontaneous uterine contraction; transforms proliferative endometrium into secretory endometrium; produces antineoplastic effect in advanced endometrial or renal carcinoma. Trade Names : Amen- Tablets 10 mg Curretab- Tablets 10mg Cycrin- Tablets 2.5 mg - Tablets 5 mg - Tablets 10 mg Depo-Provera- Injection 150 mg/mL - Injection 400 mg/mL Provera - Tablets 2.5 mg - Tablets 5mg - Tablets 10 mg Apo-Medroxy (Canada) Gen-Medroxy (Canada) Provera-Pak (Canada) 2 ratio-MPA (Canada) -mostly used: Provera (http://www.pfizer.com/files/products/uspi_provera.pdf) Indications and Usage Per os (PO) - Treatment of secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance; reduction of incidence of endometrial hyperplasia in nonhysterectomized postmenopausal women receiving conjugated estrogen 0.625 mg. Parenteral - Prevention of pregnancy; adjunctive and palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma. Contraindications Hypersensitivity to progestins; current or history of thrombophlebitis, thromboembolic disorders, cerebrovascular disease, or cerebral hemorrhage; impaired liver function; breast or genital organ cancer; undiagnosed vaginal bleeding; missed abortion; diagnostic test for pregnancy; known or suspected pregnancy. Dosage and Administration Abnormal Uterine Bleeding-Adults -PO 5 to 10 mg/day for 5 to 10 days beginning on 16th or 21st day of menstrual cycle. Contraceptive-Adults -IM 150 mg every 3 mo. Endometrial or Renal Carcinoma-Adult - Initial -IM 400 to 1,000 mg/wk. - Maintenance -IM 400 mg/mo. Reduction of Endometrial Hyperplasia-Adults -PO 5 to 10 mg daily for 12 to 14 consecutive days per month, beginning on the 1st or 16th day of cycle. Secondary Amenorrhea-Adults- PO 5 to 10 mg/day for 5 to 10 days. 3 Adverse Reactions Cardiovascular-Thrombophlebitis; edema. CNS-Depression; headache; nervousness; dizziness; insomnia; fatigue; somnolence. Dermatologic-Rash; acne; melasma; chloasma; alopecia; hirsutism; photosensitivity; pruritus; urticaria. GI-Abdominal pain or discomfort; nausea. Genitourinary-Breakthrough bleeding; spotting; change in menstrual flow; amenorrhea; decrease in libido; changes in cervical erosion and secretions. Hepatic-Cholestatic jaundice. Respiratory-Pulmonary embolism. Miscellaneous-Breast tenderness; masculinization of female fetus; edema; weight changes, especially weight gain; anaphylactoid reactions; bone mineral density changes, increasing risk of osteoporosis; hyperglycemia; pyrexia; galactorrhea 1.b) HRT Hormone replacement therapy (HRT)- also known as Hormone therapy (HT), is a system of medical treatment for surgically menopausal, perimenopausal and postmenopausal women. Prescription drugs used most often when treating menopause symptoms include both Estrogen therapy (ET) and combination of hormones- Estrogen plus progestogen therapy (EPT). Menopause is defined as the final menstrual period (FMP). It represents the permanent cessation of menses resulting from loss of ovarian follicular function due to aging. Menopause can occur naturally on average around age 51 or it can be induced by a medical intervention (surgery, chemotherapy, pelvic radiation therapy).Women are said to be postmenopausal when menstruation has ceased for 6 to 12 months and blood serum levels of follicle stimulating hormone (FSH) increase to at least 49 IU/L. The decline in circulating estrogen around the time of the menopause can induce symptoms that affect the well being and health of women: hot flushes, insomnia, declining bone mass, night sweats, mood disturbances and vaginal dryness have all been reported. Estrogen therapy has been used for 4 the treatment of many of the menopausal symptoms, particulary hot flushes and vaginal dryness. Variety of progestogens are used in HRT, classified according to their structure or bioactivity. The main reason for combining estrogen and progestogen in HRT is to protect the endometrium from developing endometrial hyperplasia,which is regarded as a precursor of endometrial cancer. The risk of hyperplasia and/or carcinoma appears to increase with higher doses and increased duration of unopposed estrogen treatment. Adding a progesteron to estrogen therapy significantly reduces the risk of hyperplasia (Furness 2009) but can result in premenstrual symptoms which cause problems for some women. These symptoms and increased bleeding and spotting are often given as a reason to discontinue HRT. HRT is an effective treatment for women with menopausal symptoms of hot flushes, night sweats and vaginal dryness and the duration of therapy shoud be decided for individual women based on an assessment of both benefits, in terms of menopausal symptom managment and harms of therapy, such as venous thromboembolism. The duration of treatment with HRT shoud be reviewed by a woman with her doctor, because for most women hot flushes resolve within a year of onset of the menopause. 2.Search strategy Inclusion criteria: -Subjects: Healthy postmenopausal women (incl.surgical menopause) -Intervention: Medroxyprogesterone acetate 5mg per os (alone or in combination with other substances) -Indication: Hormone Replacement Therapy (HRT) -Included study designs: Systematic Review Articles and Randomised Controlled Trials (RCT) -Outcomes: Safety and Efficacy Search History: 1. exp Hormone Replacement Therapy/ 2. hormone replacement.mp. 3. exp Medroxyprogesterone/ 4. medroxyprogesterone acetate.mp. 5. MPA.mp. 6. 1 or 2 7. 3 or 4 or 5 5 8. 6 and 7 9. exp Hormone Replacement Therapy/ 10. hormone replacement.mp. 11. exp Medroxyprogesterone/ 12. medroxyprogesterone acetate.mp. 13. MPA.mp. 14. 9 or 10 15. 11 or 12 or 13 16. 14 or 15 Figure 1. Flow Diagram Records identified through Additional records identified database searching(CCRCT) through other sources(CDSR+DARE) (n =624) (n =15+7) Identification Records after duplicates removed (n =624+15+7) Screening Records screened Records excluded, with (n =624+15+7) reasons* (n =531+14+7) Articles assessed for Articles excluded (n =12) eligibility (n =93+1) Eligibility Studies included Included 6 (n =81+1) Identification of clinical evidence Ovid SP Database resources were searched: EBM Reviews- Cochrane Database of Systematic Reviews (2005 to September 2010), EBM Reviews- Cochrane Central Register of Controlled Trials (4th Quarter 2010) and EBM Reviews-Database of Abstracts of Reviews of Effects ( 3rd Quarter 2010) were searched to identify all published papers and reports evaluating the effectiveness of MPA in Hormone Replacement Therapy. *reasons for articles exclusion: non-english, different hormone (only estrogen therapy or another progesterone), comorbidity in postmenopausal women, different dosage and/or aplication, different indication (contraception, endometriosis, hyperandrogenism). **abbreviations used: MPA-medroxyprogesterone acetate, E2-estradiol, EV-estradiol valerate, CEE- conjugated equine estrogen,TE-transdermal estrogen, E1S- estriol sulfate , 17bE2- 17beta estradiol, CPA- cyproterone acetate, QoL-Quality of life. ------------------------------------------------------------ Table 1. Systematic reviews evaluating the effectiveness of MPA in HRT No. Article; Search strategy Selection criteria; Outcomes Conclusions; Comment 1. Furness (2009)
Load more

Recommended publications
  • 35 Cyproterone Acetate and Ethinyl Estradiol Tablets 2 Mg/0
    PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION PrCYESTRA®-35 cyproterone acetate and ethinyl estradiol tablets 2 mg/0.035 mg THERAPEUTIC CLASSIFICATION Acne Therapy Paladin Labs Inc. Date of Preparation: 100 Alexis Nihon Blvd, Suite 600 January 17, 2019 St-Laurent, Quebec H4M 2P2 Version: 6.0 Control # 223341 _____________________________________________________________________________________________ CYESTRA-35 Product Monograph Page 1 of 48 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION ....................................................................... 3 SUMMARY PRODUCT INFORMATION ............................................................................................. 3 INDICATION AND CLINICAL USE ..................................................................................................... 3 CONTRAINDICATIONS ........................................................................................................................ 3 WARNINGS AND PRECAUTIONS ....................................................................................................... 4 ADVERSE REACTIONS ....................................................................................................................... 13 DRUG INTERACTIONS ....................................................................................................................... 16 DOSAGE AND ADMINISTRATION ................................................................................................ 20 OVERDOSAGE ....................................................................................................................................
    [Show full text]
  • The Progestogen Only Pill
    The Progestogen Only Pill Mini-pill or POP A service provided by page 2 of 8 How does the progestogen only pill (POP) work? The progestogen only pill mainly works by thickening the mucus you produce from your cervix. This makes it more difficult for sperm to get to the egg. It can also sometimes stop your ovaries from producing an egg (ovulation). How effective is the pill? The effectiveness of the pill depends on the woman taking it. At best it is over 98% effective (when no pills are missed). However failure rates can be much higher (9-15%) if women do not remember to take their pill properly. Missed pills can lead to pregnancy. Advantages of the POP • It doesn’t interfere with sex. • You can use it whilst you are breastfeeding. • It is useful if you cannot take oestrogen (the hormone contained in the combined oral contraceptive) • Can be used at any age even if you smoke and are over 35 years of age. • It may help with premenstrual symptoms and painful periods. page 3 of 8 Disadvantages of the POP • You have to remember to take your pill at the same time every day. • Your periods may become irregular or even stop altogether on the POP, this is not dangerous but if you miss a period you need to check that you are not pregnant by coming to clinic for a pregnancy test. • You may get some temporary side effects, such as spotty skin, breast tenderness and mood changes, though these should stop within a few months.
    [Show full text]
  • Download PDF File
    Ginekologia Polska 2019, vol. 90, no. 9, 520–526 Copyright © 2019 Via Medica ORIGINAL PAPER / GYNECologY ISSN 0017–0011 DOI: 10.5603/GP.2019.0091 Anti-androgenic therapy in young patients and its impact on intensity of hirsutism, acne, menstrual pain intensity and sexuality — a preliminary study Anna Fuchs, Aleksandra Matonog, Paulina Sieradzka, Joanna Pilarska, Aleksandra Hauzer, Iwona Czech, Agnieszka Drosdzol-Cop Department of Pregnancy Pathology, Department of Woman’s Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland ABSTRACT Objectives: Using anti-androgenic contraception is one of the methods of birth control. It also has a significant, non-con- traceptive impact on women’s body. These drugs can be used in various endocrinological disorders, because of their ability to reduce the level of male hormones. The aim of our study is to establish a correlation between taking different types of anti-androgenic drugs and intensity of hirsutism, acne, menstrual pain intensity and sexuality . Material and methods: 570 women in childbearing age that had been using oral contraception for at least three months took part in our research. We examined women and asked them about quality of life, health, direct causes and effects of that treatment, intensity of acne and menstrual pain before and after. Our research group has been divided according to the type of gestagen contained in the contraceptive pill: dienogest, cyproterone, chlormadynone and drospirenone. Ad- ditionally, the control group consisted of women taking oral contraceptives without antiandrogenic component. Results: The mean age of the studied group was 23 years ± 3.23. 225 of 570 women complained of hirsutism.
    [Show full text]
  • Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals
    Journal of Clinical Medicine Review Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals Carlotta Cocchetti 1, Jiska Ristori 1, Alessia Romani 1, Mario Maggi 2 and Alessandra Daphne Fisher 1,* 1 Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; [email protected] (C.C); jiska.ristori@unifi.it (J.R.); [email protected] (A.R.) 2 Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, 50139 Florence, Italy; [email protected]fi.it * Correspondence: fi[email protected] Received: 16 April 2020; Accepted: 18 May 2020; Published: 26 May 2020 Abstract: Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.
    [Show full text]
  • Comparing the Effects of Combined Oral Contraceptives Containing Progestins with Low Androgenic and Antiandrogenic Activities on the Hypothalamic-Pituitary-Gonadal Axis In
    JMIR RESEARCH PROTOCOLS Amiri et al Review Comparing the Effects of Combined Oral Contraceptives Containing Progestins With Low Androgenic and Antiandrogenic Activities on the Hypothalamic-Pituitary-Gonadal Axis in Patients With Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis Mina Amiri1,2, PhD, Postdoc; Fahimeh Ramezani Tehrani2, MD; Fatemeh Nahidi3, PhD; Ali Kabir4, MD, MPH, PhD; Fereidoun Azizi5, MD 1Students Research Committee, School of Nursing and Midwifery, Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic Of Iran 2Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic Of Iran 3School of Nursing and Midwifery, Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic Of Iran 4Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic Of Iran 5Endocrine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic Of Iran Corresponding Author: Fahimeh Ramezani Tehrani, MD Reproductive Endocrinology Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences 24 Parvaneh Yaman Street, Velenjak, PO Box 19395-4763 Tehran, 1985717413 Islamic Republic Of Iran Phone: 98 21 22432500 Email: [email protected] Abstract Background: Different products of combined oral contraceptives (COCs) can improve clinical and biochemical findings in patients with polycystic ovary syndrome (PCOS) through suppression of the hypothalamic-pituitary-gonadal (HPG) axis. Objective: This systematic review and meta-analysis aimed to compare the effects of COCs containing progestins with low androgenic and antiandrogenic activities on the HPG axis in patients with PCOS.
    [Show full text]
  • COMPARISON of ORAL DYDROGESTERONE and INTRAMUSCULAR PROGESTERONE in the TREATMENT of THREATENED ABORTION -..:: Biomedica
    ORIGINAL ARTICLE COMPARISON OF ORAL DYDROGESTERONE AND INTRAMUSCULAR PROGESTERONE IN THE TREATMENT OF THREATENED ABORTION QING G., HONG Y., FENG X. AND WEI R. Northwest Women’s Hospital, Xian City, Shanxi Province, China ABSTRACT Background and Objective: Threatened abortion is a common condition and presents with varied cli- nical manifestations. The aim of the study was to observe and analyze the efficacy and safety of dydro- gesterone in threatened abortion. Methods: One hundred and seventy two pregnant women with early – threatened abortion diagnosed during prenatal care in Northwest Women’s Hospital from January 2012 to December 2013, were sele- cted and randomly divided into dydrogesterone group and the progesterone group. Patients received either oral dydrogesterone or progesterone injected intramuscularly, respectively. The clinical efficacy and safety of both drugs were observed. Results: There were no significant differences in age, gravidity, parity and gestational age between the two groups (p> 0.05) and there was no significant difference in progesterone levels following treatment (p > 0.05). There were no significant differences in the success rate of fetus protection, abortion rate and treatment time between the groups (p > 0.05). Conclusion: Dydrogesterone and progesterone have significant beneficial effects in the treatment of threatened abortion, and they are easy to use and safe. Keywords: Threatened abortion; Dydrogestrone; Progesterone injection. INTRODUCTION gen and has a significant role in the prevention of early Threatened abortion is a common condition, and the contractions of the myometrium.4 It plays a key role in clinical manifestations are as follows: vaginal bleeding, inducing a protective immunomodulatory effect on the with or without lower abdominal pain, non-dilatation embryo.
    [Show full text]
  • How to Select Pharmacologic Treatments to Manage Recidivism Risk in Sex Off Enders
    How to select pharmacologic treatments to manage recidivism risk in sex off enders Consider patient factors when choosing off -label hormonal and nonhormonal agents ® Dowden Healthex offenders Media traditionally are managed by the criminal justice system, but psychiatrists are fre- Squently called on to assess and treat these indi- CopyrightFor personalviduals. use Part only of the reason is the overlap of paraphilias (disorders of sexual preference) and sexual offending. Many sexual offenders do not meet DSM criteria for paraphilias,1 however, and individuals with paraphil- ias do not necessarily commit offenses or come into contact with the legal system. As clinicians, we may need to assess and treat a wide range of sexual issues, from persons with paraphilias who are self-referred and have no legal involvement, to recurrent sexual offenders who are at a high risk of repeat offending. Successfully managing sex offenders includes psychological and pharmacologic interven- 2009 © CORBIS / TIM PANNELL 2009 © CORBIS / tions and possibly incarceration and post-incarceration Bradley D. Booth, MD surveillance. This article focuses on pharmacologic in- Assistant professor terventions for male sexual offenders. Department of psychiatry Director of education Integrated Forensics Program University of Ottawa Reducing sexual drive Ottawa, ON, Canada Sex offending likely is the result of a complex inter- play of environment and psychological and biologic factors. The biology of sexual function provides nu- merous targets for pharmacologic intervention, in- cluding:2 • endocrine factors, such as testosterone • neurotransmitters, such as serotonin. The use of pharmacologic treatments for sex of- fenders is off-label, and evidence is limited. In general, Current Psychiatry 60 October 2009 pharmacologic treatments are geared toward reducing For mass reproduction, content licensing and permissions contact Dowden Health Media.
    [Show full text]
  • Comparison of the Efficacy of Tibolone and Transdermal Estrogen in Treating Menopausal Symptoms in Postmenopausal Women
    https://doi.org/10.6118/jmm.19205 J Menopausal Med 2019;25:123-129 pISSN: 2288-6478, eISSN: 2288-6761 ORIGINAL ARTICLE Comparison of the Efficacy of Tibolone and Transdermal Estrogen in Treating Menopausal Symptoms in Postmenopausal Women Hyun Kyun Kim, Sung Hye Jeon, Ki-Jin Ryu, Tak Kim, Hyuntae Park Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea Objectives: This study aimed to compare the efficacy of tibolone and transdermal estrogen in treating menopausal symptoms in postmenopausal women with an intact uterus. Methods: Overall, 26 women consumed tibolone orally and 31 women received transdermal estrogen gel mixed with progestogen. The menopause rating scale (MRS) was used to assess their menopausal symptoms at their first outpatient visit and 6 months later. Results: The transdermal estrogen group showed significant improvements in more items of the MRS questionnaire. There was a favorable change in body weight in the transdermal estrogen group compared with that in the tibolone group. Depressive mood, irritability, physical and mental exhaustion, sexual and bladder problems, and joint and muscular discomfort improved only in the transdermal estrogen group, whereas heart discomfort and vaginal dryness improved only in the tibolone group. Nevertheless, the intergroup differences in each item were insignificant after adjusting for body mass index and hypertension, which differed before treatment. Conclusions: Both the therapeutic options improved menopausal symptoms within 6 months of use. However, transdermal estrogen appeared to be more effective in preventing weight gain in menopausal women than tibolone. Key Words: Hormone replacement therapy, Menopause, Tibolone, Transdermal estrogens INTRODUCTION placement therapy (HRT) increases blood coagulabil- ity by increasing clotting factor levels and decreasing Menopausal symptoms such as hot flushes, affect up antithrombin activity [3].
    [Show full text]
  • WHO Statement on Progestogen-Only Implants
    WHO statement on Progestogen-only implants Key facts Progestogen-only implants consist of hormone-filled capsules or rods that are inserted under the skin in a woman’s upper arm The purpose of this Statement is to reiterate and Life-Saving Commodities for Women and Children clarify the existing (current) WHO position based on endorsed contraceptive implants as one of its 13 Life- published guidance that is still valid. WHO monitors Saving Commodities. the evidence in this field closely and will update Primary mechanisms of action of the implants include its guidance as and when new evidence becomes thickening cervical mucus (making it difficult for available. sperm to penetrate) and preventing ovulation in KEY FACTS ABOUT PROGESTOGEN-ONLY IMPLANTS about half of menstrual cycles. Long-acting reversible contraceptives, including USE OF PROGESTOGEN-ONLY IMPLANTS BY intrauterine devices and implants are the most WOMEN LIVING WITH HIV effective methods of reversible contraception. These There have been concerns from recent publications methods have multiple advantages over other regarding the effectiveness of progestogen-only reversible methods. Most importantly, once in place, implants among women living with HIV and on they do not require daily or monthly dosing and their some antiretroviral drugs.1 However, compared with duration of contraceptive action ranges from 3 to 5 other hormonal methods, no significant differences years. in pregnancy rates have been observed with Progestogen-only implants consist of hormone-filled progestogen-only implants.2 capsules or rods that are inserted under the skin of a woman’s upper arm. Current systems consist of one or two rods.
    [Show full text]
  • Pp375-430-Annex 1.Qxd
    ANNEX 1 CHEMICAL AND PHYSICAL DATA ON COMPOUNDS USED IN COMBINED ESTROGEN–PROGESTOGEN CONTRACEPTIVES AND HORMONAL MENOPAUSAL THERAPY Annex 1 describes the chemical and physical data, technical products, trends in produc- tion by region and uses of estrogens and progestogens in combined estrogen–progestogen contraceptives and hormonal menopausal therapy. Estrogens and progestogens are listed separately in alphabetical order. Trade names for these compounds alone and in combination are given in Annexes 2–4. Sales are listed according to the regions designated by WHO. These are: Africa: Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe America (North): Canada, Central America (Antigua and Barbuda, Bahamas, Barbados, Belize, Costa Rica, Cuba, Dominica, El Salvador, Grenada, Guatemala, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago), United States of America America (South): Argentina, Bolivia, Brazil, Chile, Colombia, Dominican Republic, Ecuador, Guyana, Paraguay,
    [Show full text]
  • Determination of 17 Hormone Residues in Milk by Ultra-High-Performance Liquid Chromatography and Triple Quadrupole Mass Spectrom
    No. LCMSMS-065E Liquid Chromatography Mass Spectrometry Determination of 17 Hormone Residues in Milk by Ultra-High-Performance Liquid Chromatography and Triple Quadrupole No. LCMSMS-65E Mass Spectrometry This application news presents a method for the determination of 17 hormone residues in milk using Shimadzu Ultra-High-Performance Liquid Chromatograph (UHPLC) LC-30A and Triple Quadrupole Mass Spectrometer LCMS- 8040. After sample pretreatment, the compounds in the milk matrix were separated using UPLC LC-30A and analyzed via Triple Quadrupole Mass Spectrometer LCMS-8040. All 17 hormones displayed good linearity within their respective concentration range, with correlation coefficient in the range of 0.9974 and 0.9999. The RSD% of retention time and peak area of 17 hormones at the low-, mid- and high- concentrations were in the range of 0.0102-0.161% and 0.563-6.55% respectively, indicating good instrument precision. Method validation was conducted and the matrix spike recovery of milk ranged between 61.00-110.9%. The limit of quantitation was 0.14-0.975 g/kg, and it meets the requirement for detection of hormones in milk. Keywords: Hormones; Milk; Solid phase extraction; Ultra performance liquid chromatograph; Triple quadrupole mass spectrometry ■ Introduction Since 2008’s melamine-tainted milk scandal, the With reference to China’s national standard GB/T adulteration of milk powder has become a major 21981-2008 "Hormone Multi-Residue Detection food safety concern. In recent years, another case of Method for Animal-derived Food - LC-MS Method", dairy product safety is suspected to cause "infant a method utilizing solid phase extraction, ultra- sexual precocity" (also known as precocious puberty) performance liquid chromatography and triple and has become another major issue challenging the quadrupole mass spectrometry was developed for dairy industry in China.
    [Show full text]
  • Luteal Phase Support Using Oral Dydrogesterone-A Prospective Treatment for Future Replacing Micronized Vaginal Progesterone
    Open Access Journal of Reproductive System and L UPINE PUBLISHERS Sexual Disorders Open Access DOI: 10.32474/OAJRSD.2018.01.000119 ISSN: 2641-1644 Review article Luteal Phase Support using Oral Dydrogesterone-a Prospective Treatment for Future Replacing Micronized Vaginal Progesterone Kulvinder Kochar Kaur1*, Gautam Allahbadia2 and Mandeep Singh3 1Scientific Director, Centre For Human Reproduction, Punjab, India 2Department of Obstetrics and Gynecology, Mumbai, India 3Department of Neurology, Swami Satyanand Hospital, Punjab, India Received: September 03, 2018; Published: September 10, 2018 *Corresponding author: Jalandhar-144001, Punjab, India Kulvinder Kochar Kaur, Scientific Director, Centre For Human Reproduction 721, G.T.B. Nagar, Abstract Although micronized vaginal progesterone is the accepted norm for use in luteal phase support (LPS) in controlled ovarian stimulation (COS) that is used for in vitro fertilization (IVF) cycles, recently importance of oral Dydrogesterone has got the overimportance micronized in lieu vaginal of its progesteroneoral availability, and cheap, it seems no Dcumbersome might soon sidebecome effects the andstandard no definitive of care fornewer LPS fetalin conventional side effects. IVF After cycles the besidesLOTUS 1 its trial routine with indicationa multicenter for recurrentdouble placebo, abortions. double dummy design it has proved an equal efficacy if not superiority of oral D, Keywords: Abbreviations:LPS; COS; IVF; Dydrogesterone; Micronized vaginal progesterone LPS: Luteal Phase Support; COS: Controlled Ovarian Stimulation; IVF: In Vitro Fertilization; ET: Embryo Transfer Dydrogesterone(D)-Pharmacology growth along with corpus luteum formation and maintenance. A potent orally active progesterone receptor agonist D was humans [6], although in recent times 20mg/d of D got used as an Clinically used doses of 5-30mg, they do not suppress ovulation in developed in the1950’s.
    [Show full text]