Arnaldo Porcile

Long-term treatment of hirsutism: desogestrel compared with cyproterone acetate in oral contraceptives *

OBJECTIVE Effectiveness of 2-year treatment of hirsutism with low estrogen oral contraceptives (OCs) containing nonandrogenic or antiandrogenic progestogen. Evaluation of changes in plasma lipids. DESIGN Ten patients treated with desogestrel 150 micrograms + 30 micrograms ethinyl estradiol, 6 with desogestrel 150 micrograms + 50 micrograms ethinyl estradiol, 10 with cyproterone acetate 2 mg + 35 micrograms ethinyl estradiol. Random allocation. Paired comparisons. CONTROL GROUP 19 normal women, not treated. SETTING Academic tertiary care. PATIENTS Women with hirsutism (idiopathic and/or polycystic ovary), 24 of 26 completed treatment. INTERVENTION Two-year treatment. MAIN OUTCOME MEASURES Hirsutism score, plasma testosterone, and lipids. RESULTS Initial hirsutism scores (11.8 +/- 0.6 SE) declined with treatment (-7.2 +/- 0.4, P less than 0.01) to 4.7 +/- 0.6, almost reaching control (3.6 +/- 0.3). Initial plasma cholesterol (4.33 mmol/L +/- 0.30 SE), similar to control (4.78 +/- 0.24), increased slowly over 2 years (+2.04 +/- 0.34, P less than 0.01). High-density lipoproteins cholesterol (1.05 mmol/L +/- 0.04 SE), similar to control (1.12 +/- 0.07), did not change the 1st year and increased at 2 years (+0.57 +/- 0.11, P less than 0.01). No differences appeared among treatment groups. CONCLUSIONS Treatment is very effective, 2 years for best results. The OCs tested are equally efficacious. Changes in plasma lipids are of some concern but of difficult interpretation.

Release of norepinephrine from human ovary: coupling to steroidogenic response.

We investigated the possibility that norepinephrine from the human ovary is released after nerve stimulation and that this neurotransmitter is coupled to a steroidogenic response. Biologically significant levels of both norepinephrine and dopamine were found in human ovarian biopsies. [3H]norepinephrine incorporated in vitro was readily released by electrical stimulation in a Ca2+-dependent process. Ovarian membrane preparations exhibited specific binding sites for the β-adrenergic antagonist [3H]dihydroalprenolol. displacement of [3H]dihydroalprenolol with zinterol (a specific β2-agonist, indicated that 72% of these sites were type β2-receptors. β-receptors were also present on granulosa cells. Stimulation of granulosa cells with luteinizing hormone or the β-agonist isoproterenol increased the release of progesterone after 4 d in culture. These results suggest that the sympathetic nerves present in human ovary are coupled to β-adrenergic receptors present in endocrine cells and, as in nonprimate mammals, appear to participate in the regulation of ovarian function.

Oral contraceptives containing desogestrel in the maintenance of the remission of hirsutism: Monthly versus bimonthly treatment

A treatment to keep hirsutism in remission while minimizing lipid disturbances was attempted in 20 formerly hirsute patients with hirsutism scores already greatly reduced after oral contraceptives (OCs) treatment. After OCs discontinuation for one to three months, they were thereafter treated for two years as follows: 9 patients received ethinyl estradiol (30 micrograms/day) plus desogestrel (150 micrograms/day) in three-week cycles every month (monthly); 6 patients received the same formulation during three-week cycles every other month (bimonthly); 5 patients received no treatment. In the untreated patients, abnormal hirsutism scores reappeared within 12-18 months; the levels of testosterone and free testosterone, initially high following discontinuation of OCs, remained elevated. Monthly treatment kept hirsutism in remission, and testosterone and free testosterone levels decreased. Bimonthly treatment was equally effective keeping hirsutism in remission, although testosterone levels did not decrease. Bimonthly treatment was not better than monthly treatment in relation to changes in plasma lipids (cholesterol, HDL-cholesterol, triglycerides).

Normoprolactinemic anovulation nonresponsive to clomiphene citrate: ovulation induction with bromocriptine

Ovulation under bromocriptine was studied in 14 women with normoprolactinemic amenorrhea (5 primary, 9 secondary), unresponsive to clomiphene citrate (CC). On bromocriptine alone, ovulation occurred in 4 (28.6%). In the same subjects, bromocriptine was subsequently associated with CC. Seven patients ovulated (50.0%), including 3 that had responded to bromocriptine alone. Ovulation occurred once or twice in 6 of the 9 cases of secondary amenorrhea (66.6%). In several occasions, when ovulation induction failed, luteinized unruptured follicles were found under ultrasonographic monitoring. Four patients who had a negative response to progestin challenge did not ovulate with the treatment. Women with plasma prolactin in the upper normal range had a greater probability of achieving ovulation induction.

Quality of life in climacteric Chilean women treated with low-dose estrogen.

OBJECTIVES To evaluate the impact of low-dose oral estrogen therapy on the health-related quality of life (HRQoL) in 45-64-year-old women from the East Metropolitan Health Service (SSMO) in Santiago, Chile. MATERIAL AND METHODS We conducted an observational cross-sectional study. A random population sample of women between 45 and 64 years of age was obtained through an invitation to contact one of 15 primary health care centers of the SSMO of Santiago, Chile. Out of the 927 women who were originally contacted, 844 women were able to complete the Menopausal Rating Scale (MRS) questionnaire. Information about demographic parameters, health issues, and modality of hormonal therapy (HT) were registered. Three groups were compared: group 1 (n=647; non-users of HT), group 2 (n=82; users of low-dose oral estrogen HT), and group 3 (n=115; users of non low-dose estrogens HT). RESULTS There were no differences among groups in terms of demographic and health issue parameters. The results of the MRS scores (total score and somatic, psychological and urogenital domain scores) showed significant differences across the 3 study groups, with more favorable results for HRQoL in groups 2 and 3 (p<0.01 for total, somatic, and psychological scores; p=0.05 for urogenital score). CONCLUSION Climacteric women in the 45-64 age range using HT were shown to have a more favorable impact on HRQoL than non-HT users. Women using low-dose oral estrogen HT had a positive effect on HRQoL, similar to that obtained using non low-dose estrogen regimens.

Efecto diferencial sobre el IGF-1 sérico de tibolona (5 mg/día) vs combinado continuo de estrógeno/progestina en mujeres postmenopáusicas

: postmeno-pausal women, aged 45 to 60 years old, receiving estradiol valerate and medroxyprogesterone wereincluded in the study. After a two months wash out period, in a double blind fashion, they were ran-domly assigned to oral tibolone 5 mg/day or equine conjugated estrogens 0.625 mg + medroxiproges-terone acetate 2.5 mg/day (ECE/MPA). At baseline, 30 and 45 days of treatment, fasting serum osteo-calcin, somatomedin C (IGF-1, insulin-like growth factor 1), growth hormone (GH), and folliclestimulating hormone and first morning urine calcium and creatinine were measured.

Sertraline improves the somatic and psychological symptoms of the climacteric syndrome

ABSTRACT Objective To evaluate the efficacy of sertraline versus placebo in the management of somatic and psychological complaints of the climacteric syndrome. Methods We conducted a randomized, double-blind, placebo-controlled trial. A total of 44 women with moderate to severe complaints, defined as 16 or more points according to the Menopause Rating Scale (MRS) considering only the psychological and somatic domains, were incorporated into the trial and randomized to receive either sertraline (50 mg/day) or placebo. Both groups were evaluated at baseline and after 45 and 90 days of treatment. A reduction of 50% or more in the score was considered as a successful response. Results Thirty-three patients finished the trial (16 in the sertraline group and 17 in the placebo group), showing an odds ratio of 7.94 (95% confidence interval 1.3–57.3), p = 0.0038 for the sertraline group, in spite of the prominent effect of placebo. Conclusions Sertraline was more effective than placebo in the management of the somatic and psychological complaints of the climacteric syndrome.

Very low estrogen-desogestrel contraceptive in perimenopausal hormonal replacement

New oral contraceptives (OC) with lower estrogen contents are potentially useful for menopausal replacement. An OC with 20 micrograms ethinyl estradiol and 150 micrograms desogestrel was used for this purpose in perimenopausal women with climacteric syndrome. The treated group (N = 30), was given OC for 6 months. The control group (N = 29) was kept under observation. Serum FSH, luteinizing hormone, estradiol, cholesterol, HDL-cholesterol and triglycerides were measured. OC treatment induced prompt and clear relief of the climacteric syndrome. Endogenous serum estradiol was greatly reduced with treatment. Serum cholesterol, initially high in relation to young women, diminished with OC treatment, while HDL-cholesterol increased, significantly reducing the cholesterol/HDL-cholesterol ratio. This possibly beneficial estrogen effect was apparently not counteracted by desogestrel (a nearly non-androgenic progestogen). The initially high triglycerides were not modified by the OC. Cyclical bleeding was induced in all treated women, no atypical endometrial hyperplasia was found. This lower estrogen OC preparation may be a good alternative for estrogen replacement in perimenopausal women; its contraceptive properties may strongly appeal those needing fertility control.