Abnormal Uterine Bleeding (AUB)
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Ocps) Used in the NM Family Planning Program (FPP
The following slides are intended to familiarize nurses and clinicians with oral contraceptive pills (OCPs) used in the NM Family Planning Program (FPP). The FPP does not intend for this information to supersede the Family Planning Protocol particularly on the requirement for Public Health Nurses in the Public Health Offices to consult a clinician as stated in the Protocol when in doubt or if it is necessary to switch the client’s OCP type. 1 2 Combined oral contraceptives (COCs) contain two hormones; estrogen and progestin. In general, any combined OCP is good for most women who are eligible to take estrogen according to the CDC U.S. Medical Eligibility Criteria (MEC). Once again, refer to the US MEC chart to find out if OCP is a suitable choice for clients with specific health conditions. To learn a little bit about what each hormone does, the FPP is providing the following summary: Estrogen: provides endometrial stability = menstrual cycle control. A higher estrogen dose increases the venous thromboembolism (VTE) or clot risk but OCP clot risk is still less harmful than the clot risk related to pregnancy and giving birth. Progestin: provides most of the contraceptive effect by ‐Preventing luteinizing hormone (LH) surge /ovulation ‐Thickening the cervical mucus to prevent sperm entry. Two major OCP formations are available. Monophasic: There is only one dose of estrogen and progestin in each active pill in the packet; and Multiphasic: There are varying doses of hormones, particularly progestin in the active pills. 3 Section 3 of the FPP Protocol contains the OCP Substitute Table, which groups OCPs into 6 classes according to the estrogen dosage, the type of progestin and the formulations. -
Risk of Breast Cancer After Stopping Menopausal Hormone Therapy In
Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort Agnès Fournier, Sylvie Mesrine, Laure Dossus, Marie-Christine Boutron-Ruault, Françoise Clavel-Chapelon, Nathalie Chabbert-Buffet To cite this version: Agnès Fournier, Sylvie Mesrine, Laure Dossus, Marie-Christine Boutron-Ruault, Françoise Clavel- Chapelon, et al.. Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort. Breast Cancer Research and Treatment, Springer Verlag, 2014, 145 (2), pp.535-43. 10.1007/s10549- 014-2934-6. inserm-01319982 HAL Id: inserm-01319982 https://www.hal.inserm.fr/inserm-01319982 Submitted on 23 May 2016 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. TITLE PAGE Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort Authors : Agnès Fournier1,2,3, Sylvie Mesrine1,2,3, Laure Dossus1,2,3, Marie-Christine Boutron- Ruault1,2,3, Françoise Clavel-Chapelon1,2,3, Nathalie Chabbert-Buffet4 Affiliations: 1. Inserm, Center for research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women’s Health team, F-94807, Villejuif, France 2. Univ Paris-Sud, UMRS 1018, F-94807, Villejuif, France 3. Institut Gustave Roussy, F-94805, Villejuif, France 4. -
Classification and Pharmacology of Progestins
Maturitas 46S1 (2003) S7–S16 Classification and pharmacology of progestins Adolf E. Schindler a,∗, Carlo Campagnoli b, René Druckmann c, Johannes Huber d, Jorge R. Pasqualini e, Karl W. Schweppe f, Jos H. H. Thijssen g a Institut für Medizinische Forschung und Fortbildung, Universitätsklinikum, Hufelandstr. 55, Essen 45147, Germany b Ospedale Ginecologico St. Anna, Corso Spezia 60, 10126 Torino, Italy c Ameno-Menopause-Center, 12, Rue de France, 06000 Nice, France d Abt. für Gynäkologische Endokrinologie, AKH Wien, Währingergürtel 18-20, 1090 Wien, Austria e Institute de Puériculture26, Boulevard Brune, 75014 Paris, France f Abt. für Gynäkologie und Geburtshilfe, Ammerland Klinik, Langestr.38, 26622 Westerstede, Germany g Department of Endocrinology, Universitair Medisch Centrum Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands Abstract Besides the natural progestin, progesterone, there are different classes of progestins, such as retroprogesterone (i.e. dydroges- terone), progesterone derivatives (i.e. medrogestone) 17␣-hydroxyprogesterone derivatives (i.e. chlormadinone acetate, cypro- terone acetate, medroxyprogesterone acetate, megestrol acetate), 19-norprogesterone derivatives (i.e. nomegestrol, promege- stone, trimegestone, nesterone), 19-nortestosterone derivatives norethisterone (NET), lynestrenol, levonorgestrel, desogestrel, gestodene, norgestimate, dienogest) and spironolactone derivatives (i.e. drospirenone). Some of the synthetic progestins are prodrugs, which need to be metabolized to become active compounds. Besides -
Contraception and Misconceptions
CONTRACEPTION AND MISCONCEPTIONS CONTRACEPTION IN WOMEN WITH MENTAL ILLNESS OVERVIEW Hormones and mood How mental illness impacts on contraceptive choice Ideal contraception Pro and cons of contraceptive methods in women with mental illness Hormonal contraception and mood ESTROGENS anti-inflammatory neuroprotective effects of estradiol modulation of the limbic processing memory of emotionally-relevant information. estradiol “beneficially” modulates pathways implicated in the pathophysiology of depression, including serotonin and norepinephrine pathways PROGESTROGENS Previously thought to be anxiogenic, depressogenic Breakdown products Depression – alpha hydroxy progestrogen breakdown products pro – inflammatory, anxiogenic HORMONES AND MOODS – COMPLEX INTERPLAY MENTAL ILLNESS AND CONTRACEPTIVE CHOICE Effect of mental illness on contraceptive choice Effect of contraceptive choice on mental illness Drug interactions EFFECT MENTAL ILLNESS ON CONTRACEPTIVE CHOICE Impulsive Poor planning Cognitive and problem judgement Poor adherence IMPULSIVITY COGNITION POOR JUDGEMENT LETS NOT FORGET SUBSTANCES…… TYPES OF CONTRACEPTION No method Non hormonal Condom/Femidom Diaphragm Non hormone containing IUCD (Copper T) Hormonal COC POP Mirena Evra Patch Nuva Ring Implant ORAL CONTRACEPTIVES POP – avoid Same time every day COC Pros Effective Reduction PMS – monophasic estrogen dominant pill eg Femodene, Yaz, Nordette Cons Drug interactions Pill burden Daily dose EVRA PATCH Weekly patch Transdermal system: 150 mcg/day -
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, -
209627Orig1s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 209627Orig1s000 MULTI-DISCIPLINE REVIEW Summary Review Office Director Cross Discipline Team Leader Review Clinical Review Non-Clinical Review Statistical Review Clinical Pharmacology Review Reviewers of Multi-Disciplinary Review and Evaluation SECTIONS OFFICE/ AUTHORED/ ACKNOWLEDGED/ DISCIPLINE REVIEWER DIVISION APPROVED Mark Seggel, Ph.D. OPQ/ONDP/DNDP2 Authored: Section 4.2 Digitally signed by Mark R. Seggel -S CMC Lead DN: c=US, o=U.S. Government, ou=HHS, ou=FDA, ou=People, cn=Mark R. Signature: Mark R. Seggel -S Seggel -S, 0.9.2342.19200300.100.1.1=1300071539 Date: 2018.08.08 16:29:15 -04'00' Frederic Moulin, DVM, PhD OND/ODE3/DBRUP Authored: Section 5 Pharmacology/ Digitally signed by Frederic Moulin -S Toxicology DN: c=US, o=U.S. Government, ou=HHS, ou=FDA, ou=People, Reviewer Signature: Frederic Moulin -S 0.9.2342.19200300.100.1.1=2001708658, cn=Frederic Moulin -S Date: 2018.08.08 15:26:57 -04'00' Kimberly Hatfield, PhD OND/ODE3/DBRUP Approved: Section 5 Pharmacology/ Toxicology Digitally signed by Kimberly P. Hatfield -S DN: c=US, o=U.S. Government, ou=HHS, ou=FDA, ou=People, Team Leader Signature: Kimberly P. Hatfield -S 0.9.2342.19200300.100.1.1=1300387215, cn=Kimberly P. Hatfield -S Date: 2018.08.08 14:56:10 -04'00' Li Li, Ph.D. OCP/DCP3 Authored: Sections 6 and 17.3 Clinical Pharmacology Dig ta ly signed by Li Li S DN c=US o=U S Government ou=HHS ou=FDA ou=People Reviewer cn=Li Li S Signature: Li Li -S 0 9 2342 19200300 100 1 1=20005 08577 Date 2018 08 08 15 39 23 04'00' Doanh Tran, Ph.D. -
BRS Pharmacology
Pharmacology Gary C. Rosenfeld, Ph.D. Professor Department of Integrated Biology and Pharmacology and Graduate School of Biomedical Sciences Assistant Dean for Education Programs University of Texas Medical School at Houston Houston, Texas David S. Loose, Ph.D. Associate Professor Department of Integrated Biology and Pharmacology and Graduate School of Biomedical Sciences University of Texas Medical School at Houston Houston, Texas With special contributions by Medina Kushen, M.D. William Beaumont Hospital Royal Oak, Michigan Todd A. Swanson, M.D., Ph.D. William Beaumont Hospital Royal Oak, Michigan Acquisitions Editor: Charles W. Mitchell Product Manager: Stacey L. Sebring Marketing Manager: Jennifer Kuklinski Production Editor: Paula Williams Copyright C 2010 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, Maryland 21201-2436 USA 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care which should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages and precautions. Printed in the United States of America Library of Congress Cataloging-in-Publication Data Rosenfeld, Gary C. Pharmacology / Gary C. Rosenfeld, David S. Loose ; with special contributions by Medina Kushen, Todd A. -
Norgestrel and Gestodene Stimulate Breast Cancer Cell Growth Through an Oestrogen Receptor Mediated Mechanism
Br. J. Cancer (1993), 67, 945-952 '." Macmillan Press Ltd., 1993 Br. J. Cancer (1993), 67, 945-952 1993 Norgestrel and gestodene stimulate breast cancer cell growth through an oestrogen receptor mediated mechanism W.H. Catherino, M.H. Jeng & V.C. Jordan Department ofHuman Oncology, University of Wisconsin Comprehensive Cancer Center, 600 Highland Avenue, Madison, Wisconsin 53792, USA. Summary There is great concern over the long-term influence of oral contraceptives on the development of breast cancer in women. Oestrogens are known to stimulate the growth of human breast cancer cells, and this laboratory has previously reported (Jeng & Jordan, 1991) that the 19-norprogestin norethindrone could stimulate the proliferation of MCF-7 human breast cancer cells. We studied the influence of the 19-norprogestins norgestrel and gestodene compared to a 'non' 19- norprogestin medroxyprogesterone acetate (MPA) on MCF-7 cell proliferation. The 19-norprogestins stimulated proliferation at a concentration of 10-8 M, while MPA could not stimulate proliferation at concentrations as great as 3 x 10-6 M. The stimulatory activity of the 19-norprogestins could be blocked by the antioestrogen ICI 164,384, but not by the antiprogestin RU486. Transfection studies with the reporter plasmids containing an oestrogen response element or progesterone response element (vitERE-CAT, pS2ERE-CAT, and PRE15-CAT) were performed to determine the intracel- lular action of norgestrel and gestodene. The 19-norprogestins stimulated the vitERE-CAT activity maximally at 10-6 M, and this stimulation was inhibited by the addition of ICI 164,384. MPA did not stimulate vitERE-CAT activity. A single base pair alteration in the palindromic sequence of vitERE (resulting in the pS2ERE) led to a dramatic decrease in CAT expression by the 19-norprogestins, suggesting that the progestin activity required specific response element base sequencing. -
Estrogen and Progestin Hormone Doses in Combined Birth Control Pills
Estrogen and Progestin Hormone Doses in Combined Birth Control Pills Estrogen level Pill Brand Name Progestin Dose (mg) ethinyl estradiol (micrograms) 20 mcgm Alesse® levonorgestrel 0.10 Levlite® levonorgestrel 0.10 Loestrin 1/20® Fe norethindrone 1.00 acetate Mircette® desogestrel 0.15 Ortho Evra® norelgestromin 0.15 (patch) (norgestimate metabolite) phasic Estrostep® Fe norethindrone 1.0/1.0/1.0 20/30/35 mcgm acetate 30 mcgm Levlen® levonorgestrel 0.15 Levora® levonorgestrel 0.15 Nordette® levonorgestrel 0.15 Lo/Ovral® norgestrel 0.30 Desogen® desogestrel 0.15 Ortho-Cept® desogestrel 0.15 Loestrin® 1.5/30 norethindrone 1.50 acetate Yasmin® drospirenone 3.0 phasic Triphasil® levonorgestrel 0.05/0.075/0.125 30/40/30 mcgm Tri-Levlen® levonorgestrel 0.05/0.075/0.125 Trivora® levonorgestrel 0.05/0.075/0.125 35 mcgm Ortho-Cyclen® norgestimate 0.25 Ovcon-35® norethindrone 0.40 Brevicon® norethindrone 0.50 Modicon® norethindrone 0.50 Necon® norethindrone 1.00 Norethin® norethindrone 1.00 Norinyl® 1/35 norethindrone 1.00 Ortho-Novum® 1/35 norethindrone 1.00 Demulen® 1/35 ethynodiol diacetate 1.00 Zovia® 1/35E ethynodiol diacetate 1.00 phasic Ortho-Novum® norethindrone 0.50/1.00 35/35 mcgm 10/11 Jenest® norethindrone 0.50/1.00 phasic Ortho-Tri-Cyclen® norgestimate 0.15/0.215/0.25 35/35/35 mcgm Ortho-Novum® norethindrone 0.50/0.75/1.00 7/7/7 Tri-Norinyl® norethindrone 0.50/1.00/0.50 50 mcgm Necon® 1/50 norethindrone 1.00 Norinyl® 1/50 norethindrone 1.00 Ortho-Novum® 1/50 norethindrone 1.00 Ovcon-50® norethindrone 1.00 Ovral® norgestrel 0.50 Demulen® 1/50 ethynodiol diacetate 1.00 Zovia® 1/50E ethynodiol diacetate 1.00 Which pills have higher progestin side efects or cause more acne and hair growth? Each progestin has a diferent potency, milligram per milligram, in terms of progesterone efect to stop menstrual bleeding or androgen efect to stimulate acne and hair growth. -
U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 65 / No. 3 July 29, 2016 U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS Introduction ............................................................................................................1 Methods ....................................................................................................................2 How to Use This Document ...............................................................................3 Keeping Guidance Up to Date ..........................................................................5 References ................................................................................................................8 Abbreviations and Acronyms ............................................................................9 Appendix A: Summary of Changes from U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 ...........................................................................10 Appendix B: Classifications for Intrauterine Devices ............................. 18 Appendix C: Classifications for Progestin-Only Contraceptives ........ 35 Appendix D: Classifications for Combined Hormonal Contraceptives .... 55 Appendix E: Classifications for Barrier Methods ..................................... 81 Appendix F: Classifications for Fertility Awareness–Based Methods ..... 88 Appendix G: Lactational -
Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2Nd Edition
Morbidity and Mortality Weekly Report Early Release / Vol. 62 June 14, 2013 U.S. Selected Practice Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition Continuing Education Examination available at http://www.cdc.gov/mmwr/cme/conted.html. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Early Release CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Appendix A: Summary Chart of U.S. Medical Eligibility Criteria for Methods ....................................................................................................................2 Contraceptive Use, 2010 .................................................................................. 47 How To Use This Document ...............................................................................3 Appendix B: When To Start Using Specific Contraceptive Summary of Changes from WHO SPR ............................................................4 Methods .............................................................................................................. 55 Contraceptive Method Choice .........................................................................4 Appendix C: Examinations and Tests Needed Before Initiation of Maintaining Updated Guidance ......................................................................4 Contraceptive Methods -
Role of Androgens, Progestins and Tibolone in the Treatment of Menopausal Symptoms: a Review of the Clinical Evidence
REVIEW Role of androgens, progestins and tibolone in the treatment of menopausal symptoms: a review of the clinical evidence Maria Garefalakis Abstract: Estrogen-containing hormone therapy (HT) is the most widely prescribed and well- Martha Hickey established treatment for menopausal symptoms. High quality evidence confi rms that estrogen effectively treats hot fl ushes, night sweats and vaginal dryness. Progestins are combined with School of Women’s and Infants’ Health The University of Western Australia, estrogen to prevent endometrial hyperplasia and are sometimes used alone for hot fl ushes, King Edward Memorial Hospital, but are less effective than estrogen for this purpose. Data are confl icting regarding the role of Subiaco, Western Australia, Australia androgens for improving libido and well-being. The synthetic steroid tibolone is widely used in Europe and Australasia and effectively treats hot fl ushes and vaginal dryness. Tibolone may improve libido more effectively than estrogen containing HT in some women. We summarize the data from studies addressing the effi cacy, benefi ts, and risks of androgens, progestins and tibolone in the treatment of menopausal symptoms. Keywords: androgens, testosterone, progestins, tibolone, menopause, therapeutic Introduction Therapeutic estrogens include conjugated equine estrogens, synthetically derived piperazine estrone sulphate, estriol, dienoestrol, micronized estradiol and estradiol valerate. Estradiol may also be given transdermally as a patch or gel, as a slow release percutaneous implant, and more recently as an intranasal spray. Intravaginal estrogens include topical estradiol in the form of a ring or pessary, estriol in pessary or cream form, dienoestrol and conjugated estrogens in the form of creams. In some countries there is increasing prescribing of a combination of estradiol, estrone, and estriol as buccal lozenges or ‘troches’, which are formulated by private compounding pharmacists.