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[PMID]:29458551
[Au] Autor:Donders GGG; Bellen G; Ruban K; Van Bulck B
[Ad] Endereço:2​Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart, Tienen, Belgium.
[Ti] Título:Short- and long-term influence of the levonorgestrel-releasing intrauterine system (Mirena®) on vaginal microbiota and Candida.
[So] Source:J Med Microbiol;67(3):308-313, 2018 Mar.
[Is] ISSN:1473-5644
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recurrent vulvovaginal infections are a frequent complaint in young women in need of contraception. However, the influence of the contraceptive method on the course of the disease is not well known. AIM: To investigate the influence of the levonorgestrel-releasing intrauterine-system (LNG-IUS) on the vaginal microflora. METHODS: Short-term (3 months) and long-term (1 to 5 years) changes of vaginal microbiota were compared with pre-insertion values in 252 women presenting for LNG-IUS insertion. Detailed microscopy on vaginal fluid was used to define lactobacillary grades (LBGs), bacterial vaginosis (BV), aerobic vaginitis (AV) and the presence of Candida. Cultures for enteric aerobic bacteria and Candida were used to back up the microscopy findings. Fisher's test was used to compare vaginal microbiome changes pre- and post-insertion. RESULTS: Compared to the pre-insertion period, we found a temporary worsening in LBGs and increased rates of BV and AV after 3 months of LNG-IUS. After 1 and 5 years, however, these changes were reversed, with a complete restoration to pre-insertion levels. Candida increased significantly after long-term carriage of LNG-IUS compared to the period before insertion [OR 2.0 (CL951.1-3.5), P=0.017]. CONCLUSIONS: Short-term use of LNG-IUS temporarily decreases lactobacillary dominance, and increases LBG, AV and BV, but after 1 to 5 years these characteristics return to pre-insertion levels, reducing the risk of complications to baseline levels. Candida colonization, on the other hand, is twice as high after 1 to 5 years of LNG-IUS use, making it less indicated for long-term use in patients with or at risk for recurrent vulvovaginal candidosis.
[Mh] Termos MeSH primário: Candida/efeitos dos fármacos
Dispositivos Intrauterinos Medicados/efeitos adversos
Levanogestrel/administração & dosagem
Microbiota/efeitos dos fármacos
Vagina/microbiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Lactobacillaceae/efeitos dos fármacos
Estudos Prospectivos
Fatores de Tempo
Vaginose Bacteriana/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1099/jmm.0.000657


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[PMID]:29215513
[Au] Autor:Pal N; Broaddus RR; Urbauer DL; Balakrishnan N; Milbourne A; Schmeler KM; Meyer LA; Soliman PT; Lu KH; Ramirez PT; Ramondetta L; Bodurka DC; Westin SN
[Ad] Endereço:Department of Gynecologic Oncology and Reproductive Medicine and the Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas.
[Ti] Título:Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device.
[So] Source:Obstet Gynecol;131(1):109-116, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) for treatment of complex atypical hyperplasia or low-grade endometrial cancer. METHODS: This retrospective case series included all patients treated with the LNG-IUD for complex atypical hyperplasia or early-grade endometrial cancer from January 2003 to June 2013. Response rates were calculated and the association of response with clinicopathologic factors, including age, body mass index, and uterine size, was determined. RESULTS: Forty-six patients diagnosed with complex atypical hyperplasia or early-grade endometrial cancer were treated with the LNG-IUD. Of 32 evaluable patients at the 6-month time point, 15 had complex atypical hyperplasia (47%), nine had G1 endometrial cancer (28%), and eight had grade 2 endometrial cancer (25%). Overall response rate was 75% (95% CI 57-89) at 6 months; 80% (95% CI 52-96) in complex atypical hyperplasia, 67% (95% CI 30-93) in grade 1 endometrial cancer, and 75% (CI 35-97) in grade 2 endometrial cancer. Of the clinicopathologic features evaluated, there was a trend toward the association of lack of exogenous progesterone effect in the pathology specimen with nonresponse to the IUD (P=.05). Median uterine diameter was 1.3 cm larger in women who did not respond to the IUD (P=.04). CONCLUSION: Levonorgestrel-releasing IUD therapy for the conservative treatment of complex atypical hyperplasia or early-grade endometrial cancer resulted in return to normal histology in a majority of patients.
[Mh] Termos MeSH primário: Hiperplasia Endometrial/tratamento farmacológico
Hiperplasia Endometrial/patologia
Neoplasias do Endométrio/tratamento farmacológico
Neoplasias do Endométrio/patologia
Dispositivos Intrauterinos Medicados
Levanogestrel/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Biópsia por Agulha
Institutos de Câncer
Estudos de Coortes
Progressão da Doença
Feminino
Seres Humanos
Imuno-Histoquímica
Meia-Idade
Invasividade Neoplásica/patologia
Estadiamento de Neoplasias
Lesões Pré-Cancerosas/tratamento farmacológico
Lesões Pré-Cancerosas/patologia
Estudos Retrospectivos
Medição de Risco
Texas
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002390


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[PMID]:28796898
[Au] Autor:Louie M; Spencer J; Wheeler S; Ellis V; Toubia T; Schiff LD; Siedhoff MT; Moulder JK
[Ad] Endereço:Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
[Ti] Título:Comparison of the levonorgestrel-releasing intrauterine system, hysterectomy, and endometrial ablation for heavy menstrual bleeding in a decision analysis model.
[So] Source:Int J Gynaecol Obstet;139(2):121-129, 2017 Nov.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A better understanding of the relative risks and benefits of common treatment options for abnormal uterine bleeding (AUB) can help providers and patients to make balanced, evidence-based decisions. OBJECTIVES: To provide comparative estimates of clinical outcomes after placement of levonorgestrel-releasing intrauterine system (LNG-IUS), ablation, or hysterectomy for AUB. SEARCH STRATEGY: A PubMED search was done using combinations of search terms related to abnormal uterine bleeding, LNG-IUS, hysterectomy, endometrial ablation, cost-benefit analysis, cost-effectiveness, and quality-adjusted life years. SELECTION CRITERIA: Full articles published in 2006-2016 available in English comparing at least two treatment modalities of interest among women of reproductive age with AUB were included. DATA COLLECTION AND ANALYSIS: A decision tree was generated to compare clinical outcomes in a hypothetical cohort of 100 000 premenopausal women with nonmalignant AUB. We evaluated complications, mortality, and treatment outcomes over a 5-year period, calculated cumulative quality-adjusted life years (QALYs), and conducted probabilistic sensitivity analysis. MAIN RESULTS: Levonorgestrel-releasing intrauterine system had the highest number of QALYs (406 920), followed by hysterectomy (403 466), non-resectoscopic ablation (399 244), and resectoscopic ablation (395 827). Ablation had more treatment failures and complications than LNG-IUS and hysterectomy. Findings were robust in probabilistic sensitivity analysis. CONCLUSIONS: Levonorgestrel-releasing intrauterine system and hysterectomy outperformed endometrial ablation for treatment of AUB.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Menorragia/terapia
Modelos Teóricos
[Mh] Termos MeSH secundário: Técnicas de Ablação Endometrial
Feminino
Seres Humanos
Histerectomia
Levanogestrel/administração & dosagem
Menorragia/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12293


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[PMID]:28766313
[Au] Autor:Shen J; Che Y; Showell E; Chen K; Cheng L
[Ad] Endereço:Centre for Clinical Research and Training, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 2140 Xie Tu Road, Shanghai, China.
[Ti] Título:Interventions for emergency contraception.
[So] Source:Cochrane Database Syst Rev;8:CD001324, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. OBJECTIVES: To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy. SEARCH METHODS: In February 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Popline and PubMed, The Chinese biomedical databases and UNDP/UNFPA/WHO/World Bank Special Programme on Human Reproduction (HRP) emergency contraception database. We also searched ICTRP and ClinicalTrials.gov as well as contacting content experts and pharmaceutical companies, and searching reference lists of appropriate papers. SELECTION CRITERIA: Randomised controlled trials including women attending services for EC following a single act of unprotected intercourse were eligible. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. The primary review outcome was observed number of pregnancies. Side effects and changes of menses were secondary outcomes. MAIN RESULTS: We included 115 trials with 60,479 women in this review. The quality of the evidence for the primary outcome ranged from moderate to high, and for other outcomes ranged from very low to high. The main limitations were risk of bias (associated with poor reporting of methods), imprecision and inconsistency. Comparative effectiveness of different emergency contraceptive pills (ECP)Levonorgestrel was associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84, 6 RCTs, n = 4750, I = 23%, high-quality evidence). This suggests that if the chance of pregnancy using Yuzpe is assumed to be 29 women per 1000, the chance of pregnancy using levonorgestrel would be between 11 and 24 women per 1000.Mifepristone (all doses) was associated with fewer pregnancies than Yuzpe (RR 0.14, 95% CI 0.05 to 0.41, 3 RCTs, n = 2144, I = 0%, high-quality evidence). This suggests that if the chance of pregnancy following Yuzpe is assumed to be 25 women per 1000 women, the chance following mifepristone would be between 1 and 10 women per 1000.Both low-dose mifepristone (less than 25 mg) and mid-dose mifepristone (25 mg to 50 mg) were probably associated with fewer pregnancies than levonorgestrel (RR 0.72, 95% CI 0.52 to 0.99, 14 RCTs, n = 8752, I = 0%, high-quality evidence; RR 0.61, 95% CI 0.45 to 0.83, 27 RCTs, n = 6052, I = 0%, moderate-quality evidence; respectively). This suggests that if the chance of pregnancy following levonorgestrel is assumed to be 20 women per 1000, the chance of pregnancy following low-dose mifepristone would be between 10 and 20 women per 1000; and that if the chance of pregnancy following levonorgestrel is assumed to be 35 women per 1000, the chance of pregnancy following mid-dose mifepristone would be between 16 and 29 women per 1000.Ulipristal acetate (UPA) was associated with fewer pregnancies than levonorgestrel (RR 0.59; 95% CI 0.35 to 0.99, 2 RCTs, n = 3448, I = 0%, high-quality evidence). Comparative effectiveness of different ECP dosesIt was unclear whether there was any difference in pregnancy rate between single-dose levonorgestrel (1.5 mg) and the standard two-dose regimen (0.75 mg 12 hours apart) (RR 0.84, 95% CI 0.53 to 1.33, 3 RCTs, n = 6653, I = 0%, moderate-quality evidence).Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73; 95% CI 0.55 to 0.97, 25 RCTs, n = 11,914, I = 0%, high-quality evidence). Comparative effectiveness of Cu-IUD versus mifepristoneThere was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74, 2 RCTs, n = 395, low-quality evidence). Adverse effectsNausea and vomiting were the main adverse effects associated with emergency contraception. There is probably a lower risk of nausea (RR 0.63, 95% CI 0.53 to 0.76, 3 RCTs, n = 2186 , I = 59%, moderate-quality evidence) or vomiting (RR 0.12, 95% CI 0.07 to 0.20, 3 RCTs, n = 2186, I = 0%, high-quality evidence) associated with mifepristone than with Yuzpe. levonorgestrel is probably associated with a lower risk of nausea (RR 0.40, 95% CI 0.36 to 0.44, 6 RCTs, n = 4750, I = 82%, moderate-quality evidence), or vomiting (RR 0.29, 95% CI 0.24 to 0.35, 5 RCTs, n = 3640, I = 78%, moderate-quality evidence) than Yuzpe. Levonorgestrel users were less likely to have any side effects than Yuzpe users (RR 0.80, 95% CI 0.75 to 0.86; 1 RCT, n = 1955, high-quality evidence). UPA users were more likely than levonorgestrel users to have resumption of menstruation after the expected date (RR 1.65, 95% CI 1.42 to 1.92, 2 RCTs, n = 3593, I = 0%, high-quality evidence). Menstrual delay was more common with mifepristone than with any other intervention and appeared to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than mifepristone (18 events in 95 women using Cu-IUD versus no events in 190 women using mifepristone, low-quality evidence). AUTHORS' CONCLUSIONS: Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA was more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was probably the main adverse effect of mifepristone and seemed to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than ECPs.
[Mh] Termos MeSH primário: Anticoncepção Pós-Coito/métodos
Anticoncepcionais Pós-Coito/administração & dosagem
[Mh] Termos MeSH secundário: Anticoncepção Pós-Coito/efeitos adversos
Anticoncepcionais Pós-Coito/efeitos adversos
Esquema de Medicação
Estradiol/administração & dosagem
Estradiol/efeitos adversos
Feminino
Seres Humanos
Dispositivos Intrauterinos de Cobre/efeitos adversos
Dispositivos Intrauterinos Medicados/efeitos adversos
Levanogestrel/administração & dosagem
Levanogestrel/efeitos adversos
Mifepristona/administração & dosagem
Mifepristona/efeitos adversos
Norpregnadienos/administração & dosagem
Norpregnadienos/efeitos adversos
Gravidez
Taxa de Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
Sexo sem Proteção
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Contraceptives, Postcoital); 0 (Norpregnadienes); 320T6RNW1F (Mifepristone); 4TI98Z838E (Estradiol); 5W7SIA7YZW (Levonorgestrel); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD001324.pub5


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[PMID]:28732067
[Au] Autor:Hasegawa S; Matsui T; Hane Y; Abe J; Hatahira H; Motooka Y; Sasaoka S; Fukuda A; Naganuma M; Hirade K; Takahashi Y; Kinosada Y; Nakamura M
[Ad] Endereço:Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan.
[Ti] Título:Thromboembolic adverse event study of combined estrogen-progestin preparations using Japanese Adverse Drug Event Report database.
[So] Source:PLoS One;12(7):e0182045, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Combined estrogen-progestin preparations (CEPs) are associated with thromboembolic (TE) side effects. The aim of this study was to evaluate the incidence of TE using the Japanese Adverse Drug Event Report (JADER) database. Adverse events recorded from April 2004 to November 2014 in the JADER database were obtained from the Pharmaceuticals and Medical Devices Agency (PMDA) website (www.pmda.go.jp). We calculated the reporting odds ratios (RORs) of suspected CEPs, analyzed the time-to-onset profile, and assessed the hazard type using Weibull shape parameter (WSP). Furthermore, we used the applied association rule mining technique to discover undetected relationships such as the possible risk factors. The total number of reported cases in the JADER contained was 338,224. The RORs (95% confidential interval, CI) of drospirenone combined with ethinyl estradiol (EE, Dro-EE), norethisterone with EE (Ne-EE), levonorgestrel with EE (Lev-EE), desogestrel with EE (Des-EE), and norgestrel with EE (Nor-EE) were 56.2 (44.3-71.4), 29.1 (23.5-35.9), 42.9 (32.3-57.0), 44.7 (32.7-61.1), and 38.6 (26.3-56.7), respectively. The medians (25%-75%) of the time-to-onset of Dro-EE, Ne-EE, Lev-EE, Des-EE, and Nor-EE were 150.0 (75.3-314.0), 128.0 (27.0-279.0), 204.0 (44.0-660.0), 142.0 (41.3-344.0), and 16.5 (8.8-32.0) days, respectively. The 95% CIs of the WSP-ß for Ne-EE, Lev-EE, and Nor-EE were lower and excluded 1. Association rule mining indicated that patients with anemia had a potential risk of developing a TE when using CEPs. Our results suggest that it is important to monitor patients administered CEP for TE. Careful observation is recommended, especially for those using Nor-EE, and this information may be useful for efficient therapeutic planning.
[Mh] Termos MeSH primário: Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética
Estrogênios/administração & dosagem
Estrogênios/efeitos adversos
Progestinas/administração & dosagem
Progestinas/efeitos adversos
Tromboembolia/induzido quimicamente
[Mh] Termos MeSH secundário: Adolescente
Adulto
Sistemas de Notificação de Reações Adversas a Medicamentos
Androstenos/administração & dosagem
Androstenos/efeitos adversos
Criança
Anticoncepcionais Orais Combinados/administração & dosagem
Anticoncepcionais Orais Combinados/efeitos adversos
Bases de Dados Factuais
Desogestrel/administração & dosagem
Desogestrel/efeitos adversos
Etinilestradiol/administração & dosagem
Etinilestradiol/efeitos adversos
Feminino
Seres Humanos
Japão
Levanogestrel/administração & dosagem
Levanogestrel/efeitos adversos
Masculino
Meia-Idade
Noretindrona/administração & dosagem
Noretindrona/efeitos adversos
Norgestrel/administração & dosagem
Norgestrel/efeitos adversos
Razão de Chances
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androstenes); 0 (Contraceptives, Oral, Combined); 0 (Estrogens); 0 (Progestins); 3J8Q1747Z2 (Norgestrel); 423D2T571U (Ethinyl Estradiol); 5W7SIA7YZW (Levonorgestrel); 81K9V7M3A3 (Desogestrel); N295J34A25 (drospirenone); T18F433X4S (Norethindrone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182045


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[PMID]:28730840
[Au] Autor:Lee JK; Schwarz EB
[Ad] Endereço:a Department of Obstetrics and Gynecology , Johns Hopkins University , Baltimore , MD , USA.
[Ti] Título:The safety of available and emerging options for emergency contraception.
[So] Source:Expert Opin Drug Saf;16(10):1163-1171, 2017 Oct.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Emergency contraception (EC) is a way to significantly reduce the chance of becoming pregnant after an episode of unprotected intercourse. Considerable data support the safety of all available and emerging options for EC. Areas covered: This review presents a comprehensive summary of the literature regarding the safety of EC as well as directions for further study. PubMed was searched for all relevant studies published prior to June 2017. Expertopinion: All available methods of EC (i.e., ulipristal acetate pills, levonorgestrel pills, and the copper-IUD), carry only mild side effects and serious adverse events are essentially unknown. The copper IUD has the highest efficacy of EC methods. Given the excellent safety profiles of mifepristone and the levonorgestrel IUD, research is ongoing related to use of these products for EC.
[Mh] Termos MeSH primário: Anticoncepção Pós-Coito/métodos
Anticoncepcionais Pós-Coito/administração & dosagem
[Mh] Termos MeSH secundário: Animais
Anticoncepção Pós-Coito/efeitos adversos
Anticoncepcionais Pós-Coito/efeitos adversos
Feminino
Seres Humanos
Dispositivos Intrauterinos de Cobre/efeitos adversos
Levanogestrel/administração & dosagem
Levanogestrel/efeitos adversos
Norpregnadienos/administração & dosagem
Norpregnadienos/efeitos adversos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contraceptives, Postcoital); 0 (Norpregnadienes); 5W7SIA7YZW (Levonorgestrel); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2017.1354985


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[PMID]:28617060
[Au] Autor:Nelson AL
[Ad] Endereço:a Obstetrics & Gynecology, College of Osteopathic Medicine of the Pacific , Western University of Health Sciences , Pomona , CA , USA.
[Ti] Título:Levonorgestrel-releasing intrauterine system (LNG-IUS 12) for prevention of pregnancy for up to five years.
[So] Source:Expert Rev Clin Pharmacol;10(8):833-842, 2017 Aug.
[Is] ISSN:1751-2441
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A new five-year low dose, smaller-framed, levonorgestrel-releasing intrauterine contraceptive system (LNG-IUS 12) has been introduced to complement the currently available systems. Areas Covered: This article will provide an overview of this new intrauterine system - its composition and its mechanisms of action as well as the results of the Phase II and III clinical trials of its efficacy, safety and tolerability. Expert Commentary: This new LNG-IUS 12 provides five-year contraceptive protection a pregnancy rate (less than 1%) in first year of use, which puts it into the top tier with the existing LNG-IUS 20 products; however, the LNG-IUS 12 does not have the high rates of amenorrhea often seen with the higher dose devices. On the other hand, this new IUD shares the smaller frame and narrower insertion tube with the lower dose LNG-IUS 8, but offers longer effective life.
[Mh] Termos MeSH primário: Anticoncepcionais Femininos/administração & dosagem
Dispositivos Intrauterinos Medicados
Levanogestrel/administração & dosagem
[Mh] Termos MeSH secundário: Amenorreia/epidemiologia
Anticoncepcionais Femininos/efeitos adversos
Relação Dose-Resposta a Droga
Feminino
Seres Humanos
Dispositivos Intrauterinos Medicados/efeitos adversos
Levanogestrel/efeitos adversos
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contraceptive Agents, Female); 5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1080/17512433.2017.1341308


  8 / 3912 MEDLINE  
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[PMID]:28601762
[Au] Autor:Cardoso PG; Rodrigues D; Madureira TV; Oliveira N; Rocha MJ; Rocha E
[Ad] Endereço:Group of Histomorphology, Physiopathology and Applied Toxicology, Interdisciplinary Centre of Marine and Environmental Research (CIIMAR/CIMAR), University of Porto, Porto, Portugal. Electronic address: pteixeira@ciimar.up.pt.
[Ti] Título:Warming modulates the effects of the endocrine disruptor progestin levonorgestrel on the zebrafish fitness, ovary maturation kinetics and reproduction success.
[So] Source:Environ Pollut;229:300-311, 2017 Oct.
[Is] ISSN:1873-6424
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Interactive effects between multiple stressors, namely climate drivers (e.g., temperature) and chemical pollution (e.g., endocrine disruptors) are poorly studied. Here, it was for the first time evaluated the combinatory effects of temperature and a synthetic progestin, levonorgestrel (LNG), on the fitness and reproductive-related endpoints of zebrafish (Danio rerio). A multi-factorial design was implemented by manipulating both temperature [setting as baseline an ambient temperature of 27 °C, against warming (+3 °C)] and LNG levels (10 ngL and 1000 ngL ). Groups of males and females were exposed sub-acutely, for 21-days. Increased temperature caused an overall decrease in the females' gonadosomatic index (GSI), during the pre-reproduction phase, LNG did not affect GSI. In addition, fecundity (number of ovulated eggs) was negatively affected by both temperature and LNG, being the effect of the latter more intense. Fish exposed to the highest LNG concentration (at both temperatures) did not reproduce, but also in those exposed to the lowest dose of progestin at a higher temperature, a complete reproductive failure occurred. These results reflect what was observed in the stereological analysis of the ovary maturation stages prior to reproduction. Accordingly, the higher the LNG concentration, the lower the degree of maturation of the ovary. This was exacerbated by the higher temperature. As to embryonated eggs, they hatched significantly faster at higher temperatures, but exposure to 10 ngL of LNG (at 27 °C) reduced significantly the hatching rate, comparing to control. Further, the recrudescence of the ovary 48 h after spawning seems to be not affected by both stressors. Our data suggest that in a future scenario of global warming and synthetic hormones exposure, the reproduction of fish species, such as the zebrafish, can be endangered, which can put at risk their success, and consequently affect the structure and functioning of associated aquatic ecosystems.
[Mh] Termos MeSH primário: Disruptores Endócrinos/toxicidade
Levanogestrel/toxicidade
Poluentes Químicos da Água/toxicidade
Peixe-Zebra/fisiologia
[Mh] Termos MeSH secundário: Animais
Feminino
Cinética
Masculino
Ovário/efeitos dos fármacos
Progestinas
Reprodução/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Endocrine Disruptors); 0 (Progestins); 0 (Water Pollutants, Chemical); 5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170612
[St] Status:MEDLINE


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[PMID]:28545268
[Au] Autor:Li T; Xu XX; Dai Y; Zhang JJ; Lang JH; Leng JH
[Ad] Endereço:Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
[Ti] Título:[Efficacy and impact on quality of life of different drug treatments after partial resection of rectovaginal endometriosis].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(5):307-313, 2017 May 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate different postoperative medications as maintenance treatment for rectovaginal endometriosis (RVE) patients after conservative surgery. RVE patients who underwent transvaginal partial excision from January 2007 to September 2016 with regular outpatient follow-up were retrospectively screened. Those followed by a levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or oral contraceptive drospirenone/ethinylestradiol (DRSP/EE) 3 mg/30 µg administration were enrolled. Variations in endometriosis-related pain, sexual function and quality of life were measured by visual analogue scale (VAS), female sexual function index (FSFI) and short form 36-item health survey (SF-36) respectively. There were a total of 102 RVE patients with 48 (47.1%, 48/102) in LNG-IUS group and 54 (52.9%, 54/102) in DRSP/EE group included. A rapid and marked improvement was observed after 3 months postoperative medical treatment compared to preoperative in both groups ( <0.01). In dysmenorrhea, for LNG-IUS group (2.5±0.8) versus (7.6±1.3; <0.01), for DRSP/EE group (2.7±0.6) versus (7.7±1.4; <0.01); in FSFI, for LNG-IUS group (23.5±2.0) versus (21.0±2.7; <0.01), for DRSP/EE group (23.4±1.2) versus (21.5±2.2; <0.01); in SF-36, both groups had obvious improvements in physical component summary and mental component summary ( <0.01), for LNG-IUS group (74±13) versus (56±19), (75±13) versus (55±17), for DRSP/EE group (73±11) versus (59±15), (75±9) versus (54±14). These effects were maintained stably and progressively during postoperative medication at 6-, 12-, 24-month follow up. Transvaginal partial excision combined postoperative LNG-IUS or DRSP/EE treatment is a safe and viable technique to alleviate pain, improve sexual function and quality of life.
[Mh] Termos MeSH primário: Androstenos/uso terapêutico
Anticoncepcionais Orais/uso terapêutico
Endometriose/tratamento farmacológico
Etinilestradiol/uso terapêutico
Levanogestrel/administração & dosagem
Qualidade de Vida
[Mh] Termos MeSH secundário: Adulto
Androstenos/administração & dosagem
Dismenorreia
Endometriose/psicologia
Endometriose/cirurgia
Etinilestradiol/administração & dosagem
Feminino
Seguimentos
Seres Humanos
Dispositivos Intrauterinos Medicados
Levanogestrel/uso terapêutico
Medição da Dor
Dor Pós-Operatória
Período Pós-Operatório
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androstenes); 0 (Contraceptives, Oral); 0 (drospirenone and ethinyl estradiol combination); 423D2T571U (Ethinyl Estradiol); 5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567X.2017.05.004


  10 / 3912 MEDLINE  
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[PMID]:28476823
[Au] Autor:Sletten ET; Arnes M; Lysa LM; Moe BT; Straume B; Orbo A
[Ad] Endereço:Department of Gynecologic Oncology, Clinic for Surgery, Cancer and Women's Diseases, University Hospital of North Norway, Tromso, Norway.
[Ti] Título:Prediction of Relapse After Therapy Withdrawal in Women with Endometrial Hyperplasia: A Long-term Follow-up Study.
[So] Source:Anticancer Res;37(5):2529-2536, 2017 05.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:AIM: To investigate whether risk of relapse of endometrial hyperplasia persists many years after successful primary therapy and whether clinical or biological markers observed at primary diagnosis may predict relapse. MATERIALS AND METHODS: A series of 57 women with endometrial hyperplasia received levonorgestrel-impregnated intrauterine system or oral progestin for three months during 1998-2000. Index biopsies were classified according to WHO1994 and D-score systems, and immunohistochemical staining for estrogen receptor α (ERα), estrogen receptor ß (ERß), progesterone receptor A (PRA), progesterone receptor B (PRB), B-cell lymphoma 2/apoptosis regulator (BCL2), BCL2-associated X protein/apoptosis regulator (BAX), paired box 2 (PAX2), and phosphatase and tensin homolog (PTEN) reported as H-scores. RESULTS: Over a follow-up of 157.8 months, 23% (10/43) of patients experienced relapse. No correlation with age, body mass index, parity, WHO94 classification, or D-score was found. Only PRA (p=0.004) and PRB (p=0.038) showed certain correlation with relapse. CONCLUSION: Endometrial hyperplasia recurs many years after successful progestin therapy. Increased expression of PRB and reduced expression of PRA significantly correlated with relapse. Our results support the importance of continuous endometrial protection and the need for new clinical surveillance guidelines.
[Mh] Termos MeSH primário: Hiperplasia Endometrial/tratamento farmacológico
Levanogestrel/uso terapêutico
Medroxiprogesterona/uso terapêutico
Progestinas/uso terapêutico
[Mh] Termos MeSH secundário: Administração Oral
Adulto
Idoso
Anticoncepcionais Femininos/administração & dosagem
Anticoncepcionais Femininos/uso terapêutico
Hiperplasia Endometrial/metabolismo
Feminino
Seguimentos
Seres Humanos
Dispositivos Intrauterinos Medicados
Levanogestrel/administração & dosagem
Medroxiprogesterona/administração & dosagem
Meia-Idade
Progestinas/administração & dosagem
Receptores de Progesterona/metabolismo
Recidiva
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Contraceptive Agents, Female); 0 (Progestins); 0 (Receptors, Progesterone); 0 (progesterone receptor A); 0 (progesterone receptor B); 5W7SIA7YZW (Levonorgestrel); HSU1C9YRES (Medroxyprogesterone)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170810
[Lr] Data última revisão:
170810
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170507
[St] Status:MEDLINE



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