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.

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.

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.

scholarly journals Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis

2018 ◽  
Vol 85 (4) ◽  
pp. 470-477 ◽  
Author(s):  
Lynn Keenan ◽  
Tyson Kerr ◽  
Marguerite Duane ◽  
Karl Van Gundy
Keyword(s):  
United States ◽  
Venous Thrombosis ◽  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
The United States ◽  
Comparable Efficacy ◽  
Healthy Women ◽  
Increased Risk ◽  
Blood Clots ◽  
The World

Background: Hormonal contraception (HC) is widely used throughout the world and has been associated with venous thrombosis (VT) such as deep vein thrombosis, pulmonary emboli, and cerebral VT. Objectives: To provide a current comprehensive overview of the risk of objectively confirmed VT with HC in healthy women compared to nonusers. Search methods: PubMed was searched from inception to April 2018 for eligible studies in the English language, with hand searching from past systematic reviews. Selection criteria: We selected original research evaluating risk of objectively confirmed VT in healthy women taking oral or nonoral HC compared with nonusers. Data collection: The primary outcome of interest was a fatal or nonfatal VT in users of HC compared to nonusers or past users. Studies with at least twenty events were eligible. Adjusted relative risks with 95 percent confidence intervals were reported. Three independent reviewers extracted data from selected studies. Results: 1,962 publications were retrieved through the search strategy, with 15 publications included. Users of oral contraception with levonorgesterol had increased risk of VT by a range of 2.79–4.07, while other oral hormonal preparations increased risk by 4.0–48.6. Levonorgestrel intrauterine devices did not increase risk. Etonogestrel/ethinyl estradiol vaginal rings increased the risk of VT by 6.5. Norelgestromin/ethinyl estradiol patches increased risk of VT by 7.9. Etonogestrel subcutaneous implants by 1.4 and depot-medroxyprogesterone by 3.6. The risk of fatal VT was increased in women aged fifteen to twenty-four by 18.8-fold. Conclusion: Users of HC have a significant increased risk of VT compared to nonusers. Current risks would project at least 300–400 healthy young women dying yearly in the United States due to HC. Women should be informed of these risks and offered education in fertility-awareness-based methods with comparable efficacy for family planning. Summary: HC is widely used throughout the world and has been associated with blood clots in the legs and lungs. We searched the literature and found the risks of currently used forms of birth control increased between three- and ninefold for blood clots for healthy women. The risks found would project 300–400 women dying from using HC each year in the United States.

The effect of different hormonal contraceptives on plasma levels of free protein S and free TFPI

2013 ◽  
Vol 109 (04) ◽  
pp. 606-613 ◽  
Author(s):  
Frans M. Helmerhorst ◽  
Kathrin Fleischer ◽  
Anders E. A. Dahm ◽  
Frits R. Rosendaal ◽  
Jan Rosing ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Oral Contraceptives ◽  
Acquired Resistance ◽  
Activated Protein C ◽  
Protein S ◽  
Hormonal Contraceptives ◽  
Free Protein ◽  
Routes Of Administration ◽  
Apc Resistance ◽  
Increased Risk

SummaryUse of combined oral contraceptives is associated with a three- to sixfold increased risk of venous thrombosis. Hormonal contraceptives induce acquired resistance to activated protein C (APC), which predicts the risk of venous thrombosis. The biological basis of the acquired APC resistance is unknown. Free protein S (PS) and free tissue factor pathway inhibitor (TFPI) are the two main determinants of APC. Our objective was to assess the effect of both hormonal and non-hormonal contraceptives with different routes of administration on free TFPI and free PS levels. We conducted an observational study in 243 users of different contraceptives and measured APC sensitivity ratios (nAPCsr), free TFPI and free PS levels. Users of contraceptives with the highest risk of venous thrombosis as reported in recent literature, had the lowest free TFPI and free PS levels, and vice versa, women who used contraceptives with the lowest risk of venous thrombosis had the highest free TFPI and free PS levels. An association was observed between levels of free TFPI and nAPCsr, and between free PS and nAPCsr. The effect of oral contraceptives on TFPI and PS is a possible explanation for the increased risk of venous thrombosis associated with oral contraceptives.

Recent Advances in Hormonal Contraceptives for Women

2008 ◽  
Vol 1 (3) ◽  
pp. 199-206
Author(s):  
D. Samba Reddy
Keyword(s):  
Birth Control ◽  
Oral Contraceptives ◽  
Hormonal Contraception ◽  
Daily Intake ◽  
Hormonal Contraceptive ◽  
Hormonal Contraceptives ◽  
Breakthrough Bleeding ◽  
Contraceptive Agents ◽  
Recent Advances ◽  
Hormone Injection

Currently, Contraceptive agents play a key role in family planning in India. Hormonal contraception is the marketed most common birth control option in women. An estimated 100 million women throughout the world use hormonal contraceptives for prevention of pregnancy. This article briefly describes the recent advances in hormonal contraceptive strategies that may minimize side effects while optimizing effective contraception. There are four types of hormonal contraceptive agents available for birth control. They include oral contraceptives pills (combined and mini-pills), contraceptive patches, hormonal implants, intrauterine devices and hormone injection agents. Oral contraceptives (OCs) are among the most widely used agents because they are highly effective when used properly. Generally, OCs are designed to simulate the 28 days of the menstrual cycle by daily intake of steroid hormones consisting of an estrogen and/or a progesterone. The primary mechanism underlying OC action is inhibition of ovulation. This action is achieved using a variety of OCs with substantially different components, doses, and side effect profile.  Two types of OC pills are widely available: combination pills; and progesterone only pills. The combined daily OC pill is composed of low dose of synthetic estrogen and progesterone. They are usually taken for 21 days with a 7 day gap during which menstruation-like bleeding occurs. Recently, there are several new OCs that have been approved to minimize the frequency and/or extent of breakthrough bleeding while achieving reliable means of contraception for the avoidance of unplanned pregnancies.

scholarly journals Life-Threatening Complications of Hormonal Contraceptives: A Case History

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Saheed Khan ◽  
Yvo M. Smulders ◽  
Johanna I. P. de Vries ◽  
Angélique M. E. Spoelstra-de Man
Keyword(s):  
Oral Contraceptives ◽  
Good Condition ◽  
Abdominal Ultrasound ◽  
Massive Pulmonary Embolism ◽  
Hormonal Contraceptives ◽  
Successful Resuscitation ◽  
Internal Bleeding ◽  
Arterial Embolisation ◽  
Heparin Anticoagulation ◽  
Life Threatening

We present a case with the rare combination of thrombotic and hemorrhagic complications of oral contraceptives. A healthy 40-year-old woman suffered from cardiac arrest due to massive pulmonary embolism, caused by oral contraceptives and immobilization during a flight. After successful resuscitation, obstructive shock necessitated thrombolysis and thereafter heparin. Anticoagulation was complicated by internal bleeding from contraceptive related hepatic adenoma. She underwent arterial embolisation, and anticoagulation was continued. On day 18, she was discharged in a good condition. Hepatic adenomas are a potential source of internal bleeding in women using oral contraceptives requiring anticoagulation. Signs of internal bleeding in such patients should prompt immediate abdominal ultrasound examination.

The influence of the body mass index (BMI) on selected parameters of the coagulation system in patients with disorders of the balance system taking oral contraceptives

2016 ◽  
Vol 70 (4) ◽  
pp. 28-34 ◽  
Author(s):  
Marzena Bielińska ◽  
Joanna Urbaniak ◽  
Krzysztof Kuśmierczyk ◽  
Jurek Olszewski ◽  
Piotr Pietkiewicz
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Oral Contraceptives ◽  
Hormonal Contraception ◽  
The Body ◽  
Coagulation System ◽  
Hormonal Contraceptives ◽  
Study Group ◽  
Balance System ◽  
Estradiol Concentration

Introduction: The objective of the paper is to evaluate the influence of the body mass index (BMI) on selected parameters of the coagulation system in patients with disorders of the balance system taking oral contraceptives. Material and methods: 105 young women participated in the study who were divided into 2 groups. Group I: 52 women disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 20–49; Group II: 53 women with no disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 18–40. Patients entering the study underwent full otoneurological examination, detailed laryngological assessment and the examination of selected parameters of the hemostasis system, including the evaluation of fibrinogen and D-dimer levels, APTT and PT, estradiol and progesterone concentrations in the blood serum and evaluation of the body mass index (BMI). Results: Central vertigo was the most common type of vertigo in the study group (59,6% of cases). Other vertigo types in this group included compensated vertigo of mixed origin (36,6% of cases) and peripheral vertigo (only 3,8% of cases), which indicates that 40.4% of the cases suffer from damage to the labyrinth. The analysis of the concentration of estradiol in the blood serum revealed, after consideration of a menstrual cycle phase, that estradiol concentration exceeded normative values significantly more often in the study group than in the control group and that estradiol concentration was significantly less frequently below the norm in the study group; the difference was statistically significant (p=0,048). The body mass index (BMI) of women participating in the study significantly correlated with the concentration of D-dimers only in the study group (p=0,35 vs p=0,012). Conclusions: Evaluating the body mass index before administering hormonal contraception can be useful to eliminate other risk factors for thromboembolism. In order to prevent potential thromboembolism episodes, administering hormonal contraception only after lowering the body mass index may also be worth considering.

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.

scholarly journals Effects of Oral, Vaginal, and Transdermal Hormonal Contraception on Serum Levels of Coenzyme Q10, Vitamin E, and Total Antioxidant Activity

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Prabhudas R. Palan ◽  
Felix Strube ◽  
Juraj Letko ◽  
Azra Sadikovic ◽  
Magdy S. Mikhail
Keyword(s):  
Antioxidant Capacity ◽  
Total Antioxidant Capacity ◽  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Premenopausal Women ◽  
Serum Levels ◽  
Vaginal Ring ◽  
Control Serum ◽  
Total Antioxidant ◽  
Contraceptive Patch

The use of the transdermal contraceptive patch is associated with greater bioavailability of ethinyl estradiol (EE) compared with contraceptive vaginal ring or oral contraceptives (OC). We compared the influences of three contraceptive methods (OC, vaginal ring, and transdermal patch) on serum levels of coenzymeQ10,α-tocopherol,γ-tocopherol and total antioxidant capacity in premenopausal women. Blood samples from 30 premenopausal women who used hormonal contraception for at least 4 months were collected. Forty subjects who did not use any contraception were studied as control. Serum levels of coenzymeQ10,α-tocopherol andγ-tocopherol were measured by high-pressure liquid chromatography. Serum samples were also assayed for total antioxidant capacity (TAOC). Serum levels of coenzymeQ10andα-tocopherol were found to be significantly lower (P<.05) in all three contraceptive users compared with controls. Contraceptive patch users had the lowest levels of coenzymeQ10levels compared with normal subjects. Serum TAOC levels were significantly lower (P<.05) among the contraceptive user groups. Alterations in coenzymeQ10andα-tocopherol induced by hormonal contraception and the potential effect(s) of exogenous ovarian hormones should be taken into consideration in future antioxidant research.

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).

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