Basic principles of diagnosis and treatment of diseases as part of hyperandrogenic syndrome

2021 ◽  
pp. 8-13
Author(s):  
I. V. Kuznetsova
Keyword(s):  
Inappropriate Prescribing ◽  
Hormonal Contraception ◽  
Real Life ◽  
Hormonal Contraceptive ◽  
Skin Lesions ◽  
Medical Specialties ◽  
Excess Production ◽  
Determining Factors ◽  
Combined Hormonal Contraception

Diseases (conditions) associated with excess production of androgens in the female body or an increase in the sensitivity of hormone-dependent organs to them are united by the concept of ‘hyperandrogenic syndrome’. Its variants range from isolated skin lesions and its derivatives to systemic diseases accompanied by a high risk of menstrual irregularities, infertility, metabolic disorders, cardiovascular pathology, and carcinogenesis. The management of patients with hyperandrogenism is carried out by gynecologists, endocrinologists, dermatologists, general practitioners, but in real life, interaction between representatives of certain medical specialties, unfortunately, is rarely observed. As a result, the treatment of patients with hyperandrogenism is sinning with polypharmacy, inappropriate prescribing and ignoring the current needs of women. The situation is aggravated by the fact that there are practically no drugs annotated for the treatment of external manifestations of hyperandrogenism, and the number of drugs that can have a multifaceted effect is small. One of the strategies that can reduce the drug load and solve several problems at once to compensate for androgen-dependent dermopathies and maintain health in patients with hyperandrogenism is the appointment of combined hormonal contraception. The determining factors in the choice of a hormonal contraceptive for women with hyperandrogenism should be the presence of the antiandrogenic effect of the progestin in the composition of the drug and the safety of long-term use of the drug.

scholarly journals Clinical features of migraine with onset prior to or during start of combined hormonal contraception: a prospective cohort study

2021 ◽  
Author(s):  
Gabriele S. Merki-Feld ◽  
Peter S. Sandor ◽  
Rossella E. Nappi ◽  
Heiko Pohl ◽  
Christoph Schankin
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Natural Cycle ◽  
Free Interval ◽  
Migraine Frequency ◽  
Combined Hormonal Contraception ◽  
Migraine Onset

AbstractMany studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometriosis, but also depression or a family history might modify the course of migraine. A better understanding of migraine features linked to special hormonal situations could improve treatment. For this prospective cohort study, we conducted telephone interviews with women using a CHC and reporting withdrawal migraine to collect information on migraine frequency, intensity, triggers, symptoms, pain medication, gynaecologic history and comorbidities (n = 48). A subset of women agreed to also document their migraines in prospective diaries. The mean number of migraine days per cycle was 4.2 (± 2.7). Around 50% of these migraines occurred during the hormone-free interval. Migraine frequency was significantly higher in women who suffered from migraine before CHC start (5.0 ± 3.1) (n = 22) in comparison to those with migraine onset after CHC start (3.5 ± 2.1) (n = 26). Menstrually related attacks were described as more painful (57.5%), especially in women with migraine onset before CHC use (72%) (p < 0.02). Comorbidities were rare, except dysmenorrhea. The majority of migraine attacks in CHC users occur during the hormone-free interval. Similar as in the natural cycle, hormone-withdrawal migraines in CHC users are very intense and the response to acute medication is less good, especially in those women, who developed migraine before CHC use.

Estetrol and the possibilities of its clinical use

2021 ◽  
Vol 86 (3) ◽  
pp. 217-221
Author(s):  
Petr Křepelka ◽  
Keyword(s):  
Ethinyl Estradiol ◽  
Fetal Liver ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Cardiovascular Complications ◽  
Estradiol Valerate ◽  
Planned Parenthood ◽  
Menopausal Syndrome ◽  
Contraceptive Effectiveness ◽  
Combined Hormonal Contraception

Summary Combined hormonal contraceptive methods are one of the most commonly used methods of planned parenthood. They show high contraceptive effectiveness, reasonable cycle control and bring several non-contraceptive benefits. A limitation of the widespread use of combined hormonal contraception is the risk of cardiovascular complications in individuals with specific risk factors. The risk of cardiovascular complications is related to the used estrogen component. Currently, the most common use of estrogen in combined hormonal contraception is ethinyl estradiol and estradiol valerate. The good estrogenic part of combined oral contraceptives is estetrol, a hormone produced exclusively by the fetal liver. Estetrol exhibits a tissue-selective receptor activity. Unlike previously used estrogens, it does not negatively affect the production of liver proteins and blood clotting parameters. Estetrol is not a perspective for combined hormonal contraception only. It is also promising for treating and preventing osteoporosis, hormonal therapy of menopausal syndrome, and vulvovaginal atrophy syndrome.

scholarly journals Vaginal hormonal ring: a modern method for prolonged contraception

2020 ◽  
pp. 61-66
Author(s):  
A. Z. Khashukoeva ◽  
S. A. Khlynova ◽  
S. B. Kerchelaeva ◽  
M. V. Burdenko
Keyword(s):  
Ethinyl Estradiol ◽  
Unwanted Pregnancy ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Modern Method ◽  
Modern Medicine ◽  
Ease Of Use ◽  
Contraceptive Effect ◽  
Combined Hormonal Contraception ◽  
Indications For Use

Protection of women’s reproductive health and fertility is one of the priorities for the modern medicine. The prevention of an unintended pregnancy is critical for successful solving of this problem. Prevention of unwanted pregnancy and abortion, medical and social counselling are an integral part of the obstetrician-gynecologist activities. The effectiveness of preventing an unwanted pregnancy is a major factor in choosing a remedy, as well as the ease of use. The article presents information on the new modern contraception methods, including prolonged forms of combined hormonal contraception. A comparative analysis of oral and parenteral contraceptives is provided. The authors gave criteria of efficacy and principles for rational choice of contraceptives. The mechanism of action of a hormonal contraceptive drug containing etonogestrel and ethinyl estradiol is described. The article reviews the main advantages, indications for use and side effects of hormonal releasing systems, which contraceptive effect is provided by a combination of various factors. The suppression of ovulation is the most important of these factors. The researchers provided an analysis of the effect of the vaginal hormonal ring on the biocenosis of vagina and cervical mucosa, on the course of background cervix diseases and the possibility of preventing the development of pathogenic flora, as well as the benefits of its use in women with uncomplicated ectopia of the cervix: the effect on the epithelization of ectopia of columnar epithelium and the beneficial effect on endometrioid heterotopia. The article presents data on the frequency of adverse effects associated with the use of the contraceptive method, as well as risk factors that may become a contraindication to the use of the vaginal hormonal ring. Clear guidelines for postabortion contraception are provided.

scholarly journals OPÇÕES CONTRACEPTIVAS PARA REDUÇÃO DE EVENTOS TROMBOEMBÓLICOS EM MULHERES DIABÉTICAS

2019 ◽  
Vol 6 (1) ◽  
pp. 63-69
Author(s):  
Andressa Daiana Nascimento do Carmo ◽  
Adroaldo Lunardelli
Keyword(s):  
Diabetes Mellitus ◽  
Adverse Events ◽  
Absolute Risk ◽  
Hormonal Contraception ◽  
Public Health Problem ◽  
Hormonal Contraceptive ◽  
Diabetic Patients ◽  
Thromboembolic Events ◽  
Contraceptive Methods ◽  
Combined Hormonal Contraception

Introdução: A diabetes mellitus é um grave e crescente problema de saúde pública, podendo levar à consequências irreversíveis na saúde de seus portadores, prevendo-se crescimento no número de novos portadores para os próximos anos. O uso de métodos contraceptivos hormonais também cresceu nos últimos anos, e com o retardamento das gestações, estes números tendem a aumentar ainda mais. A prescrição de contracepção hormonal para mulheres diabéticas deve ser cuidadosamente avaliada, pois a presença da doença já confere risco para eventos adversos à saúde da paciente, em especial os eventos tromboembólicos. Objetivos: O estudo objetivou revisar a literatura quanto aos métodos contraceptivos hormonais mais adequados para pacientes diabéticos, buscando redução de eventos adversos e melhora na qualidade de vida destes. Materiais e métodos: Trata-se de uma revisão integrativa da literatura onde foram acessadas as bases de dados Medline/Pubmed, ScienceDirect e Scielo. Utilizou-se os descritores contraceptive, thrombosis e diabetes, bem como a combinação destas palavras. Resultados: Foram encontrados 4 trabalhos que se enquadraram na temática do estudo e foram incluídos na revisão. Apenas 1 foi realizado exclusivamente com pacientes diabéticas. Conclusão: A utilização de contracepção hormonal combinada apresenta a mesma probabilidade de causar eventos tromboembólicos em mulheres com e sem diabetes, mas o risco absoluto em mulheres com diabetes é maior devido à doença, que é um agravante para estes incidentes. mulheres diabéticas que utilizam contracepção com estrogênio têm risco maior de desenvolver complicações trombóticas quando comparadas às que utilizam progestogênio ou as não usuárias. Palavras-chave: diabetes mellitus; anticoncepção; estrogênios; progesterona; tromboembolia. ABSTRACT Introduction: Diabetes mellitus is a serious and growing public health problem, and may lead to irreversible consequences for the health of its patients, with a projected increase in the number of new patients for the coming years. The use of hormonal contraceptive methods has also grown in recent years, and with the delay of pregnancies, these numbers tend to increase even more. The prescription of hormonal contraception for diabetic women should be carefully evaluated, since the presence of the disease already confers risk to adverse events to the patient's health, especially thromboembolic events. Objective: The present study aimed to review the literature regarding on the most appropriate hormonal contraceptive methods for diabetic patients, seeking to reduce adverse events and improve their quality’s life. Materials and Methods: It is an integrative literature review conducted by searching the databases Medline/Pubmed, ScienceDirect and Scielo. The following descriptors were used: contraceptive, thrombosis and diabetes, as well as the combination of these words. Results: Four papers were found that fit the theme of the study and were included in the review. Only 1 was performed exclusively with diabetic patients. Conclusion: Using combined hormonal contraception has the same probability of causing thromboembolic events in women with and without diabetes, but the absolute risk in women with diabetes is greater because of the disease, which is an aggravating factor for these incidents. Diabetic women who use estrogen contraception are at greater risk of developing thrombotic complications when compared to those using progestogen or non-users. Keywords: diabetes mellitus; contraception; estrogens; progesterone; thromboembolism

Hormonal contraception

2011 ◽  
pp. 1185-1197
Author(s):  
Bliss Kaneshiro ◽  
Alison Edelman
Keyword(s):  
Intrauterine Device ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Sexual Revolution ◽  
Hormonal Contraceptives ◽  
Grading System ◽  
Eligibility Criteria ◽  
Published Evidence ◽  
Combined Hormonal Contraception ◽  
The 1960S

The first widely available hormonal contraceptive method, the birth control pill, was first introduced in the 1960s. It was both a response to, and a reflection of, the societal and philosophical currents of the time. The idea that fertility could be controlled, pregnancy planned, and population stabilized to decrease poverty, manifested reason and rationalism, as well as the concept that science could be used to improve life. Indeed, the increased utilization of various hormonal contraceptive methods over the last four decades is now regarded as one of the most successful public health ventures of our time. Money spent on family planning services has been estimated to result in more than triple the savings in prenatal and neonatal costs (1). Although it is now viewed as one of the great inventions of the 20th century, hormonal contraception has also been controversial. It allowed for the separation of sex from pregnancy and reproduction, and is cited by many as a catalyst to the sexual revolution. Consequently, hormonal contraceptives have been some of the best studied and closely scrutinized medications in history. Hormonal contraceptives can be divided into two major categories, the progestin-only methods and combined hormonal contraception, which contains an oestrogen and progestin component. With all hormonal contraceptives, the progestin component has the dominant hormonal effect. The progestin component is also responsible for the mechanism of contraceptive action with the oestrogen component of the combined methods serving mainly to regulate bleeding (2). The combined hormonal methods have been constituted in the form of a pill, injection, transdermal patch, and ring. Progestin-only methods have been formulated to be delivered in the form of a pill, injection, subdermal implant, and intrauterine device (IUD). Overall, hormonal contraception has been shown to be remarkably safe, especially when compared with pregnancy, which is one of the most medically-threatening times in a woman’s life. The World Health Organization (WHO) has published evidence-based guidelines to help assist in contraceptive decision-making. The WHO Medical Eligibility Criteria utilizes a grading system to provide information about the safety of a particular method in women with medical conditions (1 = no restrictions for use; 2 = the advantages generally outweigh the risks; 3 = the risks outweigh the benefits; 4 = the risk is unacceptable). This grading system is based on an extensive review of the literature, as well as expert consensus statements (3).

Place of progestogenic oral contraceptives in gynecological practice

2019 ◽  
Vol 1 (1) ◽  
pp. 19-26
Author(s):  
I. V. Kuznetsova
Keyword(s):  
Venous Thrombosis ◽  
Oral Contraceptives ◽  
Hormonal Contraception ◽  
Review Of The Literature ◽  
Safety Issues ◽  
Routes Of Administration ◽  
Positive Effects ◽  
Combined Hormonal Contraception

The review of the literature presents data on the possible risks of using combined hormonal contraception and the possibilities of prescribing purely progestogenic contraception as an alternative to the use of combined means. Progestogen contraceptives include a group of agents with different routes of administration, doses and characteristics of progestins, which have a number of differences in the ratio of benefits and risks, availability, reversibility and other properties of contraception. Particular attention is paid to purely progestogenic tablets containing desogestrel, as a means equivalent in effectiveness to combination contraceptives, but safer. Safety issues are considered in the context of the use of breastfeeding women, as well as from the standpoint of the risk of arterial and venous thrombosis. The issues of non-contraceptive positive effects of purely progestogenic contraceptives are covered.

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