scholarly journals MECHANISMS IN ENDOCRINOLOGY: Epidemiology of hormonal contraceptives-related venous thromboembolism

2014 ◽  
Vol 171 (6) ◽  
pp. R221-R230 ◽  
Author(s):  
Justine Hugon-Rodin ◽  
Anne Gompel ◽  
Geneviève Plu-Bureau
Keyword(s):  
Venous Thromboembolism ◽  
Second Generation ◽  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Current Data ◽  
Biological Data ◽  
Sex Hormone Binding Globulin ◽  
Hormonal Contraceptives ◽  
Low Doses ◽  
Thrombotic Risk

For many years, it has been well documented that combined hormonal contraceptives increase the risk of venous thromboembolism (VTE). The third-generation pill use (desogestrel or gestodene (GSD)) is associated with an increased VTE risk as compared with second-generation (levonorgestrel) pill use. Other progestins such as drospirenone or cyproterone acetate combined with ethinyl-estradiol (EE) have been investigated. Most studies have reported a significant increased VTE risk among users of these combined oral contraceptives (COCs) when compared with users of second-generation pills. Non-oral combined hormonal contraception, such as the transdermal patch and the vaginal ring, is also available. Current data support that these routes of administration are more thrombogenic than second-generation pills. These results are consistent with the biological evidence of coagulation activation. Overall, the estrogenic potency of each hormonal contraceptive depending on both EE doses and progestin molecule explains the level of thrombotic risk. Some studies have shown a similar increased VTE risk among users of COCs containing norgestimate (NGM) as compared with users of second-generation pill. However, for this combination, biological data, based on quantitative assessment of sex hormone-binding globulin or haemostasis parameters, are not in agreement with these epidemiological results. Similarly, the VTE risk associated with low doses of EE and GSD is not biologically plausible. In conclusion, newer generation formulations of hormonal contraceptives as well as non-oral hormonal contraceptives seem to be more thrombogenic than second-generation hormonal contraceptives. Further studies are needed to conclude on the combinations containing NGM or low doses of EE associated with GSD.

Hormonal contraception as a method of social adaptation of women in modern society

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 17-21
Author(s):  
Tatyana Yu Pestrikova ◽  
Elena A Yurasova ◽  
Igor V Yurasov ◽  
Tamara D Kovaleva
Keyword(s):  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Modern Society ◽  
Well Being ◽  
Social Adaptation ◽  
Female Employment ◽  
Hormonal Contraceptives ◽  
Aim Analysis ◽  
Positive Effects ◽  
Chlormadinone Acetate

Relevance. Currently, women make up more than 40% of the global workforce and more than half of students studying at universities around the world. Women's education, especially at a high level, tends to increase female employment. The mismatch of the style and rhythm of modern life with a genetically determined and working millennium reproductive program requires the choice of a specific approach to social adaptation. Aim. Analysis of literary sources on the use of hormonal contraception as a method of social adaptation. Materials and methods. To write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-10 years. The review included articles from peer-reviewed literature. Results. The review describes the features of modern hormonal contraceptives. Their non-contraceptive effects are presented. The individual non-contraceptive effects of a combined oral contraceptive containing 30 mg of ethinyl estradiol and 2 mg of chlormadinone acetate were determined. It has been established that the use of this contraceptive helps to improve the well-being and mood of patients, which allows you to actively use this contraceptive in routine clinical practice with premenstrual syndrome, dysmenorrhea, without the use of analgesics. Conclusions. The numerous positive effects of ethinyl estradiol and chlormadinone acetate allow the use of the drug as a means to increase social adaptation, and, consequently, improve the quality of life.

Sex hormone-binding globulin as a marker for the thrombotic risk of hormonal contraceptives

2012 ◽  
Vol 10 (6) ◽  
pp. 992-997 ◽  
Author(s):  
M. RAPS ◽  
F. HELMERHORST ◽  
K. FLEISCHER ◽  
S. THOMASSEN ◽  
F. ROSENDAAL ◽  
...  
Keyword(s):  
Sex Hormone ◽  
Sex Hormone Binding Globulin ◽  
Hormonal Contraceptives ◽  
Hormone Binding ◽  
Thrombotic Risk

Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

2014 ◽  
Vol 112 (07) ◽  
pp. 73-78 ◽  
Author(s):  
Thomas Bergholt ◽  
Anne Nielsen ◽  
Michael J. Paidas ◽  
Ellen Christine L. Løkkegaard ◽  
Jesper Petersen
Keyword(s):  
Venous Thromboembolism ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
First Year ◽  
The Difference ◽  
Combined Hormonal Contraception ◽  
One Year ◽  
First Time ◽  
Combined Hormonal Contraceptives

SummaryEstimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed pregnancies aged 15–49 during the period of 1995–2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives throughout the follow-up year. After childbirth, individuals that used combined hormonal contraceptives were more likely than non-users to experience VTE depicted by crude incidence ratios; however, the difference was only significant after 14 weeks. This implied that the numbers needed to harm were lower for those that used compared to those that did not use combined oral contraceptives in the initial 14 weeks postpartum. In conclusion, the use of combined hormonal contraceptives after early terminated pregnancies was not detrimental, but during the puerperal period, they should be used with caution.

scholarly journals Portal Venous Thrombosis Associated with Use of Etonogestrel/ethinyl Estradiol Vaginal Ring

2020 ◽  
Vol 4 (2) ◽  
pp. 263-266
Author(s):  
Katelynn Bailey ◽  
Michael Tranovich
Keyword(s):  
Abdominal Pain ◽  
Venous Thrombosis ◽  
Oral Contraceptives ◽  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Vaginal Ring ◽  
Hormonal Contraceptives ◽  
Term Outcome ◽  
Life Threatening ◽  
Portal Venous Thrombosis

Introduction: Portal venous thrombosis is a life-threatening cause of abdominal pain. In younger patients, heritable thrombophilias, pregnancy, tobacco use, and oral contraceptives are associated. Case Report: A 26-year-old woman prescribed contraceptive vaginal ring presented with abdominal pain and was diagnosed with an extensive portal venous thrombosis. Management included heparin and later an oral anticoagulant with good short-term outcome. Discussion: Women using hormonal contraception are approximately four times more likely to develop thromboembolism. Risk of thromboembolism is similar between users of intravaginal and oral contraceptives. Conclusion: Portal venous thrombosis must be considered in women presenting with abdominal pain who are prescribed hormonal contraceptives, including intravaginal forms.

Birth Control Pills and Hormonal Contraception (DRAFT)

2018 ◽  
Author(s):  
Barbara Bartlik ◽  
Amandeep Kaur ◽  
Chelsea Schoen ◽  
Julie Kolzet
Keyword(s):  
Birth Control ◽  
Sexual Functioning ◽  
Hormonal Contraception ◽  
Free Testosterone ◽  
Sex Hormone Binding Globulin ◽  
Hormonal Contraceptives ◽  
Clinical Case Study ◽  
Sexual Side Effects ◽  
Birth Control Pills

This chapter reviews the existing literature on the use of hormonal contraception (HC) and sexual functioning. In the cases where HC has been shown to lead to a decrease in sexual functioning, the chapter presents several hypotheses for the mechanisms that could be responsible for those changes, such as micronutrient depletion and elevations in sex hormone binding globulin with consequent reductions in free testosterone. Throughout this chapter, the authors make a case for clinicians to take care to inform patients of the potential sexual side effects of hormonal contraceptives, bearing in mind that it may be advisable for women who use them to supplement with certain vitamins and minerals. This may be an especially important consideration for women with genetic polymorphisms in methylation. The chapter concludes with a clinical case study.

Clinical relevance in present day hormonal contraception

2018 ◽  
Vol 37 (1) ◽  
Author(s):  
Pedro-Antonio Regidor
Keyword(s):  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Active Agent ◽  
Hormonal Contraceptives ◽  
Therapeutic Effects ◽  
Mode Of Application ◽  
Ovulation Inhibition ◽  
Vaginal Rings ◽  
Long Acting ◽  
Combined Hormonal Contraceptives

Abstract The contraceptive pill is an effective and very safe method to control pregnancies. It was developed 60 years ago, and despite that the composition has been the same since it was first developed (estrogen and progestogen), over the years the concentration of ethinyl estradiol has been reduced to improve tolerability. Nevertheless, progestogens are the basic active agent of hormonal contraception. The mechanism of progestogens is a multimodal one and basically three modes of contraceptive action can be distinguished: (a) A strong antigonadotrophic action leading to the inhibition of ovulation. The necessary dosage of ovulation inhibition per day is a fixed dosage that is intrinsic to each progestogen and independent of the dosage of estrogen used or the partial activities of the progestogen or the mode of application. (b) Thickening of the cervical mucus to inhibit sperm penetration and (c) desynchronization of the endometrial changes necessary for implantation. The on the market available progestogens used for contraception are either used in combined hormonal contraceptives (in tablets, patches or vaginal rings) or as progestogen only contraceptives. Progestogen only contraceptives are available as daily oral preparations, monthly injections, implants (2–3 years) and intrauterine systems (IUS). Even the long-acting progestogens are highly effective in typical use and have a very low risk profile. According to their introduction into the market, progestogens in combined hormonal contraceptives, have been described as 1st, 2nd, 3rd and 4th generation progestogens. The different structures of progestogens are derivatives from testosterone, progesterone and spironolactone. These differences in the molecular structure determine pharmacodynamic and pharmacokinetic differential effects which contribute to the tolerability and additional beneficial or therapeutic effects whether used in combined oral contraceptive (COC) or as progestogen only drugs. These differences enhance the individual options for different patient profiles. The new development of polymers for vaginal rings allowed on the one hand, the improvement of the estrogen/progestogen combination in these rings especially regarding the comfort of use for women (e.g. avoiding the use of cold chains or packages with up to 6-month rings) and on the other hand, the development of progestogen only formulations. Another future development will be the introduction of new progestogen only pills that will provide effective contraceptive protection with more favorable bleeding patterns and a maintenance of ovulation inhibition after scheduled 24-h delays in pill intake than the existing progestogen only pill (POP) with desogestrel (DES).

scholarly journals Sex hormone-binding globulin as a marker for the thrombotic risk of hormonal contraceptives: reply to a rebuttal

2013 ◽  
Vol 11 (2) ◽  
pp. 396-397 ◽  
Author(s):  
M. RAPS ◽  
F. M. HELMERHORST ◽  
K. FLEISCHER ◽  
V. A. VAN HYLCKAMA ◽  
B. H. STEGEMAN ◽  
...  
Keyword(s):  
Sex Hormone ◽  
Sex Hormone Binding Globulin ◽  
Hormonal Contraceptives ◽  
Hormone Binding ◽  
Thrombotic Risk

scholarly journals A Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism

1999 ◽  
Vol 84 (4) ◽  
pp. 1304-1310 ◽  
Author(s):  
S. Venturoli ◽  
O. Marescalchi ◽  
F. M. Colombo ◽  
S. Macrelli ◽  
B. Ravaioli ◽  
...  
Keyword(s):  
Growth Rate ◽  
Side Effects ◽  
Cyproterone Acetate ◽  
Hair Growth ◽  
Ethinyl Estradiol ◽  
Dehydroepiandrosterone Sulfate ◽  
Sex Hormone Binding Globulin ◽  
Low Doses ◽  
Significant Difference ◽  
Hair Diameter

Sixty-six hirsute women were randomized and treated with 1) flutamide (n = 15), 250 mg/day; 2) finasteride (n = 15), 5 mg/day; 3) ketoconazole (n = 16), 300 mg/day; and 4) ethinyl estradiol (EE)-cyproterone acetate (CPA; n = 20), 0.01 mg EE/day for the first week, 0.02 mg EE/day for the second week, and 0.01 mg EE/day for the third week, followed by a pause of 7 days, then 12.5 mg CPA/day added during the first 10 days of every month for 12 months. Hirsutism was evaluated by the Ferriman-Gallwey score, and hair diameter and hair growth rate were determined by a special image analysis processor in basal conditions and after 90, 180, 270, and 360 days of treatment. All treatments produced a significant decrease in the hirsutism score, hair diameter, and daily hair growth rate: flutamide, −55 ± 13%, −21 ± 14%, and −37 ± 18%; finasteride, −44 ± 13%, −16 ± 12%, and− 27 ± 14%; ketoconazole, −53 ± 18%, −14 ± 12%, and −30 ± 21%; and EE-CPA, −60 ± 18%, −20 ± 11%, and −28 ± 21%. Some differences existed among treatments with regard to effectiveness; EE-CPA and flutamide seem to be the most efficacious in improving hirsutism. For the hirsutism score, a greater decrease was seen with EE-CPA (−60 ± 18%) than with finasteride (−44 ± 13%; P < 0.01) and a greater decrease was seen with flutamide (−58 ± 18%) than with finasteride (−44 ± 13%; P < 0.05). Flutamide is the fastest in decreasing hair diameter; EE-CPA is the fastest in slowing down hair growth, even though at the end of the treatment there was a significant difference between flutamide and finasteride only (−41 ± 18% vs.− 27 ± 14%; P < 0.05). Flutamide, ketoconazole, and EE-CPA induced a significant decrease in total and free testosterone, 5α-dihydrotestosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione plasma levels. During the EE-CPA treatment, gonadotropins were suppressed, and the sex hormone-binding globulin level increased. Finasteride induced a decrease in dehydroepiandrosterone sulfate and 5α-dihydrotestosterone and an increase in testosterone levels. Very few side-effects were observed during treatment with low doses of flutamide, EE-CPA, and particularly finasteride. Flutamide induced a decrease whereas EE-CPA induced an increase in triglycerides and cholesterol, showing higher values within the normal range. Ketoconazole induced several side-effects and complications, and several people dropped out of the study. Despite different modalities of action and significantly different effects on androgen levels, low doses of flutamide, finasteride, and EE-CPA constitute very satisfactory alternative therapeutic regimens in the treatment of hirsutism.

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