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Inthavong S, Pantasri T, Morakote N, Muangmool T, Piyamongkol W, Pongsatha S, Chaovisitseree S. Change of contraceptive preference after the free-LARC program for Thai teenagers. BMC Womens Health 2022; 22:211. [PMID: 35672692 PMCID: PMC9172104 DOI: 10.1186/s12905-022-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background In 2014, the Thai government launched a free-of-charge long-acting reversible contraception (LARC) program for Thai female adolescents. However, its acceptance had not been reported. Therefore, this study aimed to describe contraceptive use among women of reproductive age before and after the program was implemented. Methods This retrospective cross-sectional study was carried out from the medical records of 9000 women of reproductive age, who attended the Family Planning Clinic at Maharaj Nakorn Chiang Mai Hospital between 2009 and 2018. The Chi-square test was used to compare the contraceptive methods administered before and after the program was implemented, and binary logistic regression was used to find the factors associated with implant use after completion of the program. Results Depot medroxy progesterone acetate (DMPA) injection was the most popular contraceptive method used among 40.9% of the women. The rates of subdermal implant use were increased significantly after the program was implemented (2.3–9.3%, p < 0.001). Implant use for adolescents aged less than 20 years increased from 2.6% to 56.4%, while DMPA was the most popular method used among adult women at 36.4%. Factors associated significantly with implant use after implement of the program included age of less than 20 years (aOR = 4.17 (CI: 1.84–9.44); p = 0.001) and nulliparity (aOR = 8.55 (CI: 3.77–19.39); p < 0.001). Conclusion This study showed a significant increase in contraceptive implant use after the free-LARC program for adolescents had been applied. Statement of implications Contraceptive implant is the most effective hormonal reversible contraception. Its use rate is low among all age groups, but increased clearly after the free-of-charge program was applied for adolescents.
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Affiliation(s)
- Sathaphone Inthavong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tawiwan Pantasri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Nuntana Morakote
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wirawit Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsak Chaovisitseree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Pandelides Z, Ussery EJ, Overturf MD, Guchardi J, Holdway DA. Inhibition of swim bladder inflation in Japanese medaka (Oryzias latipes) embryos following exposure to select pharmaceuticals alone and in combination. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2021; 234:105796. [PMID: 33713916 DOI: 10.1016/j.aquatox.2021.105796] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 02/17/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
This study leveraged the Japanese medaka fish embryo model for the assessment of effects of select contaminants on early development in fish. Fish embryos were exposed to various pharmaceutical contaminants including synthetic hormones and non-steroidal anti-inflammatory drugs and their effects on development were observed. Initial screening determined that swim bladder inflation failure was the most common endpoint detected. Swim bladder inflation failure was first explored in a study demonstrating that medaka require access to the air-water interphase to inflate their swim bladders in a time-dependent manner, and swim bladder inflation failure was correlated with mortality. Fish embryos were exposed 24-hours post fertilization until hatch to concentration ranges of various pharmaceutical contaminants including: 17β-estradiol, 17α-ethinylestradiol, and levonorgestrel (1 to 1000 µg/L), or diclofenac (0.32 to 100 mg/L). The main effect observed across all four compounds was a significant increase in failure of swim bladder inflation with increasing exposure concentration (24 to 72-hours post-hatch). Following single compound experiments combinatorial exposures using no-observed-effect concentrations were conducted. The main effect observed was a significant decrease in inflation success 24-hours post-hatch following a binary mixture of levonorgestrel and 17α-ethinylestradiol, as well as a significant decrease in swim bladder inflation success at all times following exposure to a quaternary mixture of all four compounds. This study demonstrated that embryonic exposure to pharmaceutical compounds, both alone and in combination, resulted in failure of swim bladder inflation in larval Japanese medaka.
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Affiliation(s)
- Z Pandelides
- University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada.
| | - E J Ussery
- University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada
| | - M D Overturf
- University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada
| | - J Guchardi
- University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada
| | - D A Holdway
- University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada
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Sunaga T, Cicali B, Schmidt S, Brown J. Comparison of contraceptive failures associated with CYP3A4-inducing drug-drug interactions by route of hormonal contraceptive in an adverse event reporting system. Contraception 2020; 103:222-224. [PMID: 33345974 PMCID: PMC7972989 DOI: 10.1016/j.contraception.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
Objective To estimate associations between contraceptive failures and concomitant CYP3A4-inducing medications by route of administration. Study design Comparison of unintended pregnancy outcomes within U.S. Food and Drug Administration's Adverse Event Reporting System by couse of CYP3A4-inducing drugs and route of administration for levonorgestrel and etonogestrel/desogestrel. Results Among 14,504 levonorgestrel case reports, the reporting odds ratio (ROR) was increased for oral (ROR = 4.2 [3.0–5.7]), implants (ROR = 8.0 [5.8–11.0]), but not intrauterine (ROR = 0.9 [0.6–1.3]) levonorgestrel products. For 9348 etonogestrel/desogestrel case reports, oral and vaginal products were not associated with contraceptive failure. Etonogestrel containing implants (ROR = 4.9 [4.1–5.9]) were associated with increased contraceptive failure. Conclusion Levonorgestrel containing combination oral products and implants containing levonorgestrel or etonogestrel were prone to CYP3A4-inducing drug-drug interactions that may increase contraceptive failures. Implications The progestin components of hormonal contraceptives are susceptible to drug-drug interactions, but this susceptibility is influenced by route of administration. This study provides evidence from an Adverse Event Reporting System that CYP3A4-inducing medications increase the risk of unintended pregnancy for oral and implant contraceptives but not intrauterine or vaginal devices.
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Affiliation(s)
- Tomiko Sunaga
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, United States; Showa University, School of Pharmacy, Tokyo, Japan
| | - Brian Cicali
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, University of Florida College of Pharmacy, Orlando, FL, United States
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, University of Florida College of Pharmacy, Orlando, FL, United States
| | - Joshua Brown
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, United States.
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Wiesinger H, Klein S, Rottmann A, Nowotny B, Riecke K, Gashaw I, Brudny-Klöppel M, Fricke R, Höchel J, Friedrich C. The Effects of Weak and Strong CYP3A Induction by Rifampicin on the Pharmacokinetics of Five Progestins and Ethinylestradiol Compared to Midazolam. Clin Pharmacol Ther 2020; 108:798-807. [PMID: 32275771 PMCID: PMC7540325 DOI: 10.1002/cpt.1848] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/17/2020] [Indexed: 01/28/2023]
Abstract
It is known that co‐administration of CYP3A inducers may decrease the effectiveness of oral contraceptives containing progestins as mono‐preparations or combined with ethinylestradiol. In a randomized clinical drug‐drug interaction study, we investigated the effects of CYP3A induction on the pharmacokinetics of commonly used progestins and ethinylestradiol. Rifampicin was used to induce CYP3A. The progestins chosen as victim drugs were levonorgestrel, norethindrone, desogestrel, and dienogest as mono‐products, and drospirenone combined with ethinylestradiol. Postmenopausal women (n = 12–14 per treatment group) received, in fixed sequence, a single dose of the victim drug plus midazolam without rifampicin, with rifampicin 10 mg/day (weak induction), and with rifampicin 600 mg/day (strong induction). The effects on progestin exposure were compared with the effects on midazolam exposure (as a benchmark). Unbound concentrations were evaluated for drugs binding to sex hormone binding globulin. Weak CYP3A induction, as confirmed by a mean decrease in midazolam exposure by 46%, resulted in minor changes in progestin exposure (mean decreases: 15–37%). Strong CYP3A induction, in contrast, resulted in mean decreases by 57–90% (mean decrease in midazolam exposure: 86%). Namely, the magnitude of the observed induction effects varied from weak to strong. Our data might provide an impetus to revisit the currently applied clinical recommendations for oral contraceptives, especially for levonorgestrel and norethindrone‐containing products, and they might give an indication as to which progestin could be used, if requested, by women taking weak CYP3A inducers—although it is acknowledged that the exact exposure‐response relationship for contraceptive efficacy is currently unclear for most progestins.
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Ávila JL, Almeida-Aguirre EKP, Méndez-Cuesta CA, Toscano RA, Cerbón Cervantes MA, Delgado G. Structural Reassignment of rel-(3' Z,3 R,6 R,7 R,3a' R,6' R)-3,8-Dihydrodiligustilide and the Activity of Diligustilide and 3,8-Dihydro- and 3,8,7',7a'-Tetrahydrodiligustilides as Progestins. Org Lett 2019; 21:7460-7465. [PMID: 31497973 DOI: 10.1021/acs.orglett.9b02762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several phthalides were semisynthesized, including a 3,8-dihydrodiligustilide with progesterone-like activity, previously isolated from Ligusticum chuanxiong, the structure of which was earlier assigned to a semisynthetic product with nonidentical spectroscopic constants. The structure of this natural phthalide was reassigned with a proposal of its absolute configuration. Phthalides acted as progestins in cell viability assays, immunofluorescence microscopy, and docking analysis. Therefore, the structures for natural and semisynthetic phthalides with potential use in hormone-related therapies were reassigned.
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Affiliation(s)
- José Luis Ávila
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
| | - Ericka K P Almeida-Aguirre
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
| | - Carlos A Méndez-Cuesta
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
| | - Rubén A Toscano
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
| | - Marco A Cerbón Cervantes
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
| | - Guillermo Delgado
- Instituto de Química , Universidad Nacional Autónoma de México , Ciudad Universitaria, Coyoacán 04510 , Ciudad de México , Mexico
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Skowron KJ, Booker K, Cheng C, Creed S, David BP, Lazzara PR, Lian A, Siddiqui Z, Speltz TE, Moore TW. Steroid receptor/coactivator binding inhibitors: An update. Mol Cell Endocrinol 2019; 493:110471. [PMID: 31163202 PMCID: PMC6645384 DOI: 10.1016/j.mce.2019.110471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/14/2022]
Abstract
The purpose of this review is to highlight recent developments in small molecules and peptides that block the binding of coactivators to steroid receptors. These coactivator binding inhibitors bind at the coregulator binding groove, also known as Activation Function-2, rather than at the ligand-binding site of steroid receptors. Steroid receptors that have been targeted with coactivator binding inhibitors include the androgen receptor, estrogen receptor and progesterone receptor. Coactivator binding inhibitors may be useful in some cases of resistance to currently prescribed therapeutics. The scope of the review includes small-molecule and peptide coactivator binding inhibitors for steroid receptors, with a particular focus on recent compounds that have been assayed in cell-based models.
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Affiliation(s)
- Kornelia J Skowron
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Kenneth Booker
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Changfeng Cheng
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Simone Creed
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Brian P David
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Phillip R Lazzara
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Amy Lian
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Zamia Siddiqui
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Thomas E Speltz
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA; Department of Chemistry, University of Chicago, 929 E. 57th Street, E547, Chicago, IL, 60637, USA
| | - Terry W Moore
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL, 60612, USA; University of Illinois Cancer Center, University of Illinois at Chicago, 1801 W. Taylor Street, Chicago, IL, 60612, USA.
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Effect of Progestin Usage on the Interpretation of Cervical High-grade Squamous Intraepithelial Lesion. Am J Surg Pathol 2019; 43:1066-1073. [PMID: 31045892 DOI: 10.1097/pas.0000000000001267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Progestin usage can alter the histologic and cytologic features of HSIL, which may potentially lead to the under-diagnosis of this precancerous lesion. The objective of the present study was to assess the relationship between the usage of progesterone-based contraceptives and the cytologic features of high-grade squamous intraepithelial lesion (HSIL) of the cervix. In this case-control study, we assembled 46 cases of cervical HSIL (CIN 3), including samples from 26 patients with known history of progestin usage (study group) and 20 samples from patients with no history of any exogenous hormone usage (control group). Cell image analysis was performed on all samples using a proprietary software. Immunohistochemical studies for Ki67, p16, estrogen receptor and progesterone receptor were performed on all cases, as was RNA in situ hybridization for HPV subtypes 16 and 18. Compared with the control group cases, the average nuclear size (21.5±1.80 μm) and the nuclear: cytoplasmic ratio (0.28±0.015) of HSILs in the study group cases were significantly smaller (P=0.026) and reduced (P=0.005), respectively. In addition, the study group cases showed reduced nuclear atypia and pleomorphism and significantly reduced mitotic figures (1.74±1.86/mm in study group versus 5.94±1.3/mm in control group, P<0.0001). The later was likely a consequence of the significantly reduced mitotic figures in the superficial and middle epithelial layers of the study group cases compared with their control group counterparts (0.73±0.88/mm vs. 7.3±2.6/mm, P<0.0001). Progestin usage has no discernible effects on p16 immunoreactivity, Ki67 proliferative index, hormone receptor expression, and HPV RNA levels of HSIL lesions. Being aware of progestin induced morphologic changes on those cervical precancerous lesions will be ultimately improve patient care quality in our daily practice.
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Infante M, Fabi A, Cognetti F, Gorini S, Caprio M, Fabbri A. RANKL/RANK/OPG system beyond bone remodeling: involvement in breast cancer and clinical perspectives. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:12. [PMID: 30621730 PMCID: PMC6325760 DOI: 10.1186/s13046-018-1001-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
RANKL/RANK/OPG system consists of three essential signaling molecules: i) the receptor activator of nuclear factor (NF)-kB-ligand (RANKL), ii) the receptor activator of NF-kB (RANK), and iii) the soluble decoy receptor osteoprotegerin (OPG). Although this system is critical for the regulation of osteoclast differentiation/activation and calcium release from the skeleton, different studies have elucidated its specific role in mammary gland physiology and hormone-driven epithelial proliferation during pregnancy. Of note, several data suggest that progesterone induces mammary RANKL expression in mice and humans. In turn, RANKL controls cell proliferation in breast epithelium under physiological conditions typically associated with higher serum progesterone levels, such as luteal phase of the menstrual cycle and pregnancy. Hence, RANKL/RANK system can be regarded as a major downstream mediator of progesterone-driven mammary epithelial cells proliferation, potentially contributing to breast cancer initiation and progression. Expression of RANKL, RANK, and OPG has been detected in breast cancer cell lines and in human primary breast cancers. To date, dysregulation of RANKL/RANK/OPG system at the skeletal level has been widely documented in the context of metastatic bone disease. In fact, RANKL inhibition through the RANKL-blocking human monoclonal antibody denosumab represents a well-established therapeutic option to prevent skeletal-related events in metastatic bone disease and adjuvant therapy-induced bone loss in breast cancer. On the other hand, the exact role of OPG in breast tumorigenesis is still unclear. This review focuses on molecular mechanisms linking RANKL/RANK/OPG system to mammary tumorigenesis, highlighting pre-clinical and clinical evidence for the potential efficacy of RANKL inhibition as a prevention strategy and adjuvant therapy in breast cancer settings.
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Affiliation(s)
- Marco Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Via San Nemesio, 21, 00145, Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - Stefania Gorini
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University Tor Vergata, Via San Nemesio, 21, 00145, Rome, Italy.
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10
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Combined high dose vitamin C and E increases oxidative stress and visceral fat mass in rats treated by depot-medroxyprogesterone acetate. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hua J, Han J, Wang X, Guo Y, Zhou B. The binary mixtures of megestrol acetate and 17α-ethynylestradiol adversely affect zebrafish reproduction. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 213:776-784. [PMID: 27038209 DOI: 10.1016/j.envpol.2016.03.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
Synthetic progesterones and estrogens are broadly used bioactive pharmaceutical agents and have been detected in aquatic environments. In the present study, we investigated the combined reproductive effects of megestrol acetate (MTA) and 17α-ethinylestradiol (EE2) on zebrafish. Adult zebrafish were exposed to MTA (33, 100 or 333 ng/L), EE2 (10 ng/L) or a mixture of both (MTA + EE2: 33 + 10, 100 + 10 or 333 + 10 ng/L) for 21 days. Results demonstrated that egg production was significantly reduced by exposure to 10 ng/L EE2, but not MTA. However, a combined exposure to MTA and EE2 caused further reduction of fish fecundity compared to EE2 exposure alone, suggesting an additive effect on egg production when EE2 is supplemented with MTA. Plasma concentrations of 17β-estradiol and testosterone in the females and 11-ketotestosterone in the males were significantly decreased in the groups exposed to EE2 or MTA alone compared with the solvent control, and the plasma concentrations of the three hormones were further reduced in the co-exposure groups relative to the MTA exposure group, but not the EE2 exposure group. These data indicate that the inhibitory effects on plasma concentrations in the co-exposures were predominantly caused by EE2. Furthermore, exposure to MTA and EE2 (alone or in combination) led to histological alterations in the ovaries (decreased vitellogenic/mature oocytes), but not in the testes. This study has important implications for environmental risk assessment of synthetic hormones that are concurrently present in aquatic systems.
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Affiliation(s)
- Jianghuan Hua
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jian Han
- Biology Institute of Shangdong Academy of Sciences, Jinan 250014, China
| | - Xianfeng Wang
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yongyong Guo
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China
| | - Bingsheng Zhou
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China.
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Protective Effect of Vitamins C and E on Depot-Medroxyprogesterone Acetate-Induced Ovarian Oxidative Stress In Vivo. J Toxicol 2016; 2016:3134105. [PMID: 26966434 PMCID: PMC4761384 DOI: 10.1155/2016/3134105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/28/2015] [Indexed: 11/21/2022] Open
Abstract
A study was designed to investigate ameliorates effect of combined vitamins C and E able to against depot-medroxyprogesterone acetate- (DMPA-) induced ovarian oxidative stress in rat. Twenty-five female Wistar rats were divided into the following groups (n = 5 rats each): control (untreated) (C); depot-medroxyprogesterone acetate (DMPA); DMPA plus green vitamin C (at dose of 0.2 mg/gram; 0.4 mg/gram; 0.8 mg/gram) and vitamin E (0.04 IU/gram). The treatment with combined vitamins C and E was performed for four weeks. Analysis of malondialdehyde (MDA) level as a marker of oxidative stress was done colorimetrically. Analysis of SOD level was done by enzyme linked immunosorbent assay (ELISA) technically. This increase in ovarium MDA was significantly (P < 0.05) attenuated by medium dose treatments of combined vitamins C and E. DMPA insignificantly decreased SOD levels compared to the untreated group. This decrease in ovarian SOD level was significantly attenuated by all doses of the combined vitamins C and E. In conclusion, DMPA induces ovarian oxidative stress. Combined vitamins C and E prohibit the increase in ovarian lipid peroxidation, at least in part by modulating of superoxide dismutase. Therefore, this may provide an antioxidant therapy for attenuating the ovarian toxicity found in the DMPA therapy.
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Schneider AP, Kubat C, Zainer CM. Appreciation for Analysis of how Levonorgestrel Works and Reservations with the use of Meloxicam as Emergency Contraception. Linacre Q 2016; 83:52-68. [DOI: 10.1080/00243639.2016.1145894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
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Affiliation(s)
| | - Christopher Kubat
- Catholic Social Services of Southern Nebraska, Lincoln, Nebraska, USA
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Runnalls TJ, Beresford N, Kugathas S, Margiotta-Casaluci L, Scholze M, Scott AP, Sumpter JP. From single chemicals to mixtures--reproductive effects of levonorgestrel and ethinylestradiol on the fathead minnow. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2015; 169:152-167. [PMID: 26551686 DOI: 10.1016/j.aquatox.2015.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/17/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
The aquatic environment is polluted with thousands of chemicals. It is currently unclear which of these pose a significant threat to aquatic biota. The typical exposure scenario is now represented by a widespread blanket of contamination composed of myriads of individual pollutants-each typically present at a low concentration. The synthetic steroids, 17α-ethinylestradiol and levonorgestrel, have been widely reported to be present in the aquatic environment in the low ng to sub-ng/l range. They are widely used in contraceptive formulations, both individually and in combination. Our research employed the fathead minnow (Pimephales promelas) 21 day 'pair-breeding' assay to assess reproductive output when pairs of fish were exposed to the single chemicals at low environmentally relevant concentrations, and then to a binary mixture of them. A variety of endpoints were assessed, including egg production, which was inhibited in a concentration-dependent manner by both the individual chemicals and the mixture. Significant, sex specific effects were also seen with both chemicals, at differing levels of biological organisation. Plasma concentrations of EE2 and levonorgestrel were predicted and in the case of levonorgestrel measured, and compared with the human therapeutic plasma concentrations (Read-Across approach) to support the interpretation of the results. A novel quantitative method was developed for the data analysis, which ensured a suitable endpoint for the comparative mixture assessment. This approach compares the reproductive performance from individual pairs of fish during chemical exposure to its pre-treatment performance. The responses from the empirical mixture study were compared to predictions derived from the single substance data. We hypothesised combined responses which were best described by the concept of concentration addition, and found no clear indications against this additivity expectation. However, the effect profiles support the current knowledge that both compounds act in different ways to reduce egg production in fish, and suggest that probably response addition (also called Independent action) is the more appropriate mixture model in this case.
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Affiliation(s)
- Tamsin J Runnalls
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK.
| | - Nicola Beresford
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK
| | - Subramaniam Kugathas
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK
| | - Luigi Margiotta-Casaluci
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK
| | - Martin Scholze
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK
| | - Alexander P Scott
- CEFAS Weymouth Laboratory, Barrack Road, Weymouth, Dorset, DT4 8UB, UK
| | - John P Sumpter
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex, UB83PH, UK
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15
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Overturf MD, Anderson JC, Pandelides Z, Beyger L, Holdway DA. Pharmaceuticals and personal care products: A critical review of the impacts on fish reproduction. Crit Rev Toxicol 2015; 45:469-91. [PMID: 25945515 DOI: 10.3109/10408444.2015.1038499] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Research in environmental toxicology involving pharmaceuticals and personal care products (PPCPs) has increased greatly over the last 10-15 years. Much research has been focused on the endocrine-disrupting potential of PPCPs, as they relate to negative population impacts of aquatic organisms. This review assesses the current data on the reported effects of PPCPs on fish reproduction with an emphasis on fecundity, a predictor of population effects. Studies of both individual PPCPs and PPCP mixtures are presented. As the majority of individual PPCP studies reviewed demonstrate negative effects on fish fecundity, we relate these findings to detected surface water concentrations of these compounds. Very few studies involving PPCP mixtures have been conducted; however, the need for these types of studies is warranted as fish are most likely exposed to mixtures of PPCPs in the wild. In addition, laboratory and field assessments of wastewater treatment plant (WWTP) effluents, a major source of PPCPs, are reviewed. Much of the data provided from these assessments are variable and do not generally demonstrate negative impacts on reproduction, or the studies are unable to directly associate observed effects with WWTP effluents. Finally, future research considerations are outlined to provide an avenue into understanding how wild populations of fish are affected by PPCPs. These considerations are aimed at determining the adaptation potential of fish exposed to mixtures of PPCPs over multiple generations. As global use of PPCPs continually rises, the need to discern the effects of chronic exposure to PPCPs is greatly increased.
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Affiliation(s)
- Matthew D Overturf
- Faculty of Science, University of Ontario Institute of Technology , Oshawa, ON , Canada
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16
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Reimers A, Brodtkorb E, Sabers A. Interactions between hormonal contraception and antiepileptic drugs: Clinical and mechanistic considerations. Seizure 2015; 28:66-70. [DOI: 10.1016/j.seizure.2015.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/27/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022] Open
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Abstract
Breast cancer, affecting one in eight American women, is a modern epidemic. The increasing frequency of breast cancer is widely recognized. However, the wealth of compelling epidemiological data on its prevention is generally not available, and as a consequence, is largely unknown to the public. The purpose of this report is to review the epidemiological evidence of preventable causes of breast cancer. [Table: see text].
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Affiliation(s)
| | | | | | - Nancy K Mullen
- University of Kentucky Medical Center, Lexington, KY, USA
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18
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Kamal EM, Hafez AM. Effect of copper intrauterine device vs. injectable contraceptive on serum hormone levels and cell mitotic activity in endometrium. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Kugathas S, Runnalls TJ, Sumpter JP. Metabolic and reproductive effects of relatively low concentrations of beclomethasone dipropionate, a synthetic glucocorticoid, on fathead minnows. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:2077-84. [PMID: 23869980 DOI: 10.1021/es3048834] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pharmaceuticals present in the aquatic environment could adversely affect aquatic organisms. Synthetic glucocorticoids (GC) are used in large quantities as anti-inflammatory drugs and have been reported to be present in river water. In order to assess the impact of environmental concentrations of GCs, an in vivo experiment was conducted with adult fathead minnows. Fish were exposed to 0.1 μg/L, 1 μg/L, or 10 μg/L beclomethasone dipropionate (BCMD) via a flow-through system over a period of 21 days. Similar duplicate tanks served as control, with no chemical added. There was a concentration-related increase in plasma glucose concentration and a decrease in blood lymphocyte count. Induction of male secondary sexual characters and a decreasing trend in plasma vitellogenin (Vtg) concentrations in female fish were observed with increasing exposure concentration of BCMD. Expression profiles of selected genes (phosphoenolpyruvate carboxykinase - PEPCK, glucocorticoid receptor - GR, and Vtg) in liver also demonstrated concentration-related effects at all three tested concentrations. The results suggest that GCs could cause effects in lower micrograms per liter concentrations that could be environmentally relevant for total GCs present in the environment. Therefore, studies to determine the environmental concentrations of GCs and no effect concentrations are needed to assess if GCs pose a risk to the aquatic environment.
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Affiliation(s)
- Subramaniam Kugathas
- Institute for the Environment, Brunel University , Uxbridge, Middlesex UB8 3PH, United Kingdom.
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20
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Svensson J, Fick J, Brandt I, Brunström B. The synthetic progestin levonorgestrel is a potent androgen in the three-spined stickleback (Gasterosteus aculeatus). ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:2043-2051. [PMID: 23362984 DOI: 10.1021/es304305k] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The use of progestins has resulted in contamination of aquatic environments and some progestins have in experimental studies been shown to impair reproduction in fish and amphibians at low ng L(-1) concentrations. The mechanisms underlying their reproductive toxicity are largely unknown. Some progestins, such as levonorgestrel (LNG), exert androgenic effects in mammals by activating the androgen receptor (AR). Male three-spined stickleback (Gasterosteus aculeatus) kidneys produce spiggin, a gluelike glycoprotein used in nest building, and its production is directly governed by androgens. Spiggin is normally absent in females but its production in female kidneys can be induced by AR agonists. Spiggin serves as the best known biomarker for androgens in fish. We exposed adult female sticklebacks to LNG at 5.5, 40, and 358 ng L(-1) for 21 days. Androgenic effects were found at LNG concentrations ≥40 ng L(-1) including induction of spiggin transcription, kidney hypertrophy, and suppressed liver vitellogenin transcription. These are the first in vivo quantitative data showing that LNG is a potent androgen in fish supporting the contention that androgenic effects of certain progestins contribute to their reproductive toxicity.
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Affiliation(s)
- Johan Svensson
- Department of Environmental Toxicology, Uppsala University, Norbyvägen 18A, SE-75 236 Uppsala, Sweden.
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21
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Lv X, Shi D. Combined effects of levonorgestrel and quinestrol on reproductive hormone levels and receptor expression in females of the Mongolian gerbil (Meriones unguiculatus). Zoolog Sci 2012; 29:37-42. [PMID: 22233494 DOI: 10.2108/zsj.29.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of treatment with a combination of levonorgestrel and quinestrol (EP-1; ratio of 2:1) on reproductive hormone levels and the expression of their receptors in female Mongolian gerbils were examined. We show that serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) decreased, whereas serum estradiol (E2) and progesterone (P4) increased after EP-1 treatment. EP1 down-regulated mRNA expression of the follicle-stimulating hormone receptor (FSHR) and the estrogen receptor (ER) βin the ovary. EP-1 up-regulated the mRNA expression of the luteinizing hormone receptor (LHR) and the progesterone receptor (PR) in the ovary as well as ERα and PR in the uterus of Mongolian gerbils. The effects were time-dependent and dose-dependent. EP-1 had no obvious effects on ERα mRNA expression in the ovary. The current study demonstrates that the effect of EP-1 on the expression of ER subtypes is tissue-specific in Mongolian gerbils. EP-1 disrupted the reproductive endocrinology of the Mongolian gerbil. These findings suggest that the effects of EP-1 on reproductive hormone levels and their receptor expression in Mongolian gerbils may be the result of synergistic actions of levonorgestrel and quinestrol, with quinestrol playing the major role.
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Affiliation(s)
- Xiaohui Lv
- College of Agriculture and Biotechnology, China Agricultural University, Beijing 100193, China
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22
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Säfholm M, Norder A, Fick J, Berg C. Disrupted Oogenesis in the Frog Xenopus tropicalis after Exposure to Environmental Progestin Concentrations1. Biol Reprod 2012; 86:126. [DOI: 10.1095/biolreprod.111.097378] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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23
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Hancock DB, Håberg SE, Furu K, Whitworth KW, Nafstad P, Nystad W, London SJ. Oral contraceptive pill use before pregnancy and respiratory outcomes in early childhood. Pediatr Allergy Immunol 2011; 22:528-36. [PMID: 21294776 PMCID: PMC3140614 DOI: 10.1111/j.1399-3038.2010.01135.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral contraceptive pills (OCPs) are often used soon before, and sometimes during, pregnancy. A few studies have suggested that OCP use before pregnancy may increase risks for childhood respiratory outcomes, but data are inconclusive. No studies have analyzed the two types of OCPs, estrogen-progestin combined pills and progestin-only pills, separately. METHODS In the Norwegian Mother and Child Cohort Study (MoBa), we prospectively examined associations of OCP use before pregnancy, by type, with lower respiratory tract infections in 60,225 children followed to 6 months old, lower respiratory tract infections and wheezing in 42,520 children followed to 18 months old, and asthma in 24,472 children followed to 36 months old. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) crudely and with adjustment for a wide range of potential confounders. RESULT Combined pills were used much more commonly than progestin-only pills. Taking combined pills before pregnancy was not associated with lower respiratory tract infections, wheezing, or asthma. Progestin-only pill use in the year before pregnancy had a slight positive association with wheezing at 6-8 months old [adjusted OR (95% CI) = 1.19 (1.05-1.34)]. CONCLUSION Our finding that combined pill use before pregnancy was not related to respiratory outcomes should provide reassurance to the vast majority of mothers using OCPs before becoming pregnant. The small association with progestin-only pill use and early respiratory outcomes may reflect uncontrolled confounding or other bias. Nonetheless, it does suggest that these two types of pills should be examined separately in future analyses of respiratory and other childhood outcomes.
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MESH Headings
- Adult
- Asthma/epidemiology
- Cohort Studies
- Confidence Intervals
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Estrogen Replacement Therapy/adverse effects
- Estrogen Replacement Therapy/statistics & numerical data
- Female
- Humans
- Infant
- Infant, Newborn
- Logistic Models
- Male
- Odds Ratio
- Pregnancy
- Progestins/administration & dosage
- Progestins/adverse effects
- Respiratory Sounds
- Respiratory Tract Infections/epidemiology
- Surveys and Questionnaires
- Treatment Outcome
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Affiliation(s)
- Dana B. Hancock
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Siri E. Håberg
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Furu
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, University of Tromsø, Tromsø, Norway
| | - Kristina W. Whitworth
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Per Nafstad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice and Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Wenche Nystad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
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24
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Jørgensen NP. [Contraceptive implants--aberrations from insertion and removal procedures]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:733-4. [PMID: 20379334 DOI: 10.4045/tidsskr.08.0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Contraceptive implants with progestogens are options for women who need long-term contraception. Implanon which contains etonogestrel (the active metabolite of desogestrel) effectively prohibits ovulation over a period of three years. This study presents aberrations from insertion and removal procedures for Implanon in the period 2 February 2002 - 30 June 2008. MATERIAL AND METHODS Information about sales of Implanon in Norway is taken from statistics provided by Farmastat Norway. Aberrations from procedures for insertion and removal of Implanon are based on reports from doctors to the producer. Non-palpable implants to be removed at Volvat Medical Centre in Oslo, were localized by ultrasound and removed surgically. RESULTS In the period 2 February 2002 - 30 June 2008, the producer Organon AS (now Schering- Plough AS) sold 12 898 Implanon implants in Norway and recorded 112 aberrations from existing procedures, the first one 3 March 2003. 18 patients were referred for removal of implants (too deeply inserted) at Volvat Medical Centre in the period 19 January 2004 - 30 June 2008. INTERPRETATION The number of unsuccessful or wrongly inserted implants indicates that doctors should have practiced and be better informed about insertion and removal procedures before using this method. Localization and removal of implants inserted too deeply requires high-frequency ultrasound equipment and surgical experience.
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Mani R, Pollard JR. Antiepileptic drugs and other medications: what interactions may arise? Curr Treat Options Neurol 2009; 11:253-61. [PMID: 19523351 DOI: 10.1007/s11940-009-0029-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many patients with epilepsy are on lifelong therapy with antiepileptic drugs (AEDs), and AEDs are used for other conditions such as mood stabilization and headache prophylaxis. These drugs have high potential for clinically significant interaction with nonepilepsy drugs. Interactions occur largely through altered pharmacokinetics. One drug may increase the hepatic clearance of another, leading to attenuated efficacy of the affected drug. Alternatively, inhibition of liver metabolism by one drug can cause acute toxicity by reducing clearance of another drug. To identify potential drug interactions before they lead to toxicity or therapy failure, the treating clinician should combine knowledge of the patient's overall history with a general knowledge of comorbid conditions in which significant interactions involving AEDs are most likely to occur. Treatments susceptible to interactions include anticoagulants, antiarrhythmics, antibiotics, antiretroviral drugs, immunosuppressives, antineoplastics, and contraceptives. Therefore, it is important to obtain periodically a thorough history of medical problems, use of medications or herbal remedies, and adverse effects of medications. Physicians managing epilepsy patients should also strive to avoid potential drug interactions by favoring low-interaction AEDs in patients taking many other types of drugs. There is quite a large degree of patient heterogeneity in the extent of any given interaction between an AED and another drug. Indeed, some groups of patients may have different susceptibilities to such interactions because of genetic and environmental influences on drug metabolism. Effective treatment with AEDs should include attention to drug interactions.
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Affiliation(s)
- Ram Mani
- John R. Pollard, MD Penn Epilepsy Center, Department of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Darney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril 2009; 91:1646-53. [DOI: 10.1016/j.fertnstert.2008.02.140] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 02/21/2008] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The rapid increase in the world population makes it mandatory to develop new contraceptive methods. Disseminating reversible inexpensive and practical hormonal methods to developing countries is a target of many international agencies and funds. RECENT FINDINGS The safety of combined oral contraceptives is the main issue. The main guideline is to find women at risk before prescribing combined oral contraceptives. Lowering the estrogen dose should be attempted. New progestins are emerging, but their safety can be assessed only retrospectively. There is an increasing trend to extend the cycles in order to have fewer bleeding days. Progestin-only contraception seems safer than estrogen-progestin combinations in relation to thromboembolic events. A new progestin-only pill and the levonorgestrel intrauterine system have a good acceptability and high continuation rate. New administration methods are being developed and the possible role of mifepristone has been investigated. SUMMARY There are more contraceptive choices available than ever before. To educate healthcare providers as to the methods available and to inform and educate consumers are cornerstones for successful contraception.
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Chertok IR, Zimmerman DR. Contraceptive considerations for breastfeeding women within Jewish law. Int Breastfeed J 2007; 2:1. [PMID: 17204150 PMCID: PMC1779768 DOI: 10.1186/1746-4358-2-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 01/04/2007] [Indexed: 12/29/2022] Open
Abstract
Breast milk has been shown to have multiple benefits to infant health and development. Therefore, it is important that maternal contraceptive choices consider the effects on lactation. Women who observe traditional Jewish law, halakha, have additional considerations in deciding the order of preference of contraceptive methods due to religious concerns including the use of barrier and spermicidal methods. In addition, uterine bleeding, a common side effect of hormonal methods and IUD, can have a major impact on the quality of intimacy and marital life due to the laws of niddah. This body of Jewish laws prohibits any physical contact from the onset of uterine bleeding until its cessation and for an additional week. Health care professionals should understand the issues of Jewish law involved in modern contraceptive methods in order to work in tandem with the halakha observant woman to choose a contraceptive method that preserves the important breastfeeding relationship with her infant and minimizes a negative impact on intimacy with her husband.
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Affiliation(s)
- Ilana R Chertok
- West Virginia University School of Nursing, Morgantown, West Virginia, USA
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
| | - Deena R Zimmerman
- TEREM Immediate Medical Services, Israel
- Nishmat: The Jerusalem Center for Advanced Jewish Study for Women, Jerusalem, Israel
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Abstract
The progestins have different pharmacologic properties depending upon the parent molecule, usually testosterone or progesterone (P), from which they are derived. Very small structural changes in the parent molecule may induce considerable differences in the activity of the derivative. In hormonal contraceptives, progestins represent the major agent designed for suppressing ovulation and are used in combination with estrogen (E) usually ethinyl-estradiol (EE). The development of new generations of progestins with improved selectivity profiles has been a great challenge. Steroidal and nonsteroidal progesterone receptor (PR) agonists have been synthesized as well, although the latter are still in a very early stage of development. Several new progestins, have been synthesized in the last two decades. These include dienogest (DNG), drospirenone (DRSP), Nestorone (NES), nomegestrol acetate (NOMAc) and trimegestone (TMG). These new progestins have been designed to have no androgenic or estrogenic actions and to be closer in activity to the physiological hormone P. DRSP differs from the classic progestins as it is derived from spirolactone. It is essentially an antimineralocorticoid steroid with no androgenic effect but a partial antiandrogenic effect. The antiovulatory potency of the different progestins varies. TMG and NES are the most potent progestins synthesized to date, followed by two of the older progestins, keto-desogestrel (keto-DSG) and levonorgestrel (LNG). The new molecules TMG, DRSP and DNG also have antiandrogenic activity. Striking differences exist regarding the side effects among the progestins and the combination with EE leads to other reactions related to the E itself and whether the associated progestin counterbalances, more or less, the estrogenic action. The 19-norprogesterone molecules and the new molecules DRSP and DNG are not androgenic and, therefore, have no negative effect on the lipid profile. Given their pharmacological properties, it is likely that the new progestins may have neutral effects on metabolic or vascular risks. However, this hypothesis must be confirmed in large clinical trials.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000185331.32574.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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