Rogério Bonassi Machado

Bleeding patterns and menstrual-related symptoms with the continuous use of a contraceptive combination of ethinylestradiol and drospirenone: a randomized study.

BACKGROUND The objective of this study was to compare bleeding patterns of women using a contraceptive combination of 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) continuously or cyclically. Menstrual-related symptoms were also evaluated. STUDY DESIGN This open, prospective, randomized study evaluated 78 women using the EE/DRSP combination continuously for 168 days or for six 28-day cycles, each followed by a 7-day hormone-free interval. A diary with pre-established scales was used to assess the frequency and intensity of bleeding and menstrual-related symptoms. RESULTS Amenorrhea increased with continuous use; 62.2% of women with continuous use were amenorrheic at the end of treatment (95% CI: 46.6-77.8%). Dysmenorrhea, headache, acne, nausea, edema and increased appetite improved significantly in the continuous-use group, and mastalgia and edema in the cyclic-use group (p<.05). Six subjects in the continuous-use group (15.4%) and three in the cyclic-use group (7.7%) discontinued due to adverse events. CONCLUSIONS Continuous use was associated with amenorrhea and fewer menstrual-related symptoms compared to cyclic use.

Effect of a continuous regimen of contraceptive combination of ethinylestradiol and drospirenone on lipid, carbohydrate and coagulation profiles

BACKGROUND The objective of this study was to evaluate the effects of a contraceptive pill containing ethinylestradiol (30 mcg) and drospirenone (3 mg) in a continuous regimen on lipid, carbohydrate and coagulation parameters. STUDY DESIGN This open, prospective, randomized study included 78 participants (mean age 27.8 years) who were randomized into two groups to use the pill continuously for 168 days or for six 28-day cycles with a 7-day hormone-free interval between cycles. Markers of lipid, carbohydrate and coagulation profiles were measured prior to initiation and after the 6 months of pill use. RESULTS No statistically significant differences were found between the two contraceptive regimens with respect to carbohydrate or lipid profiles or in the parameters related to coagulation. CONCLUSIONS The contraceptive combination of ethinylestradiol and drospirenone used in a continuous regimen was associated with metabolic alterations similar to those found during the traditional cyclic regimen of oral contraceptive use.

Effects of estradiol and norethisterone on lipids, insulin resistance and carotid flow.

OBJECTIVES To evaluate the lipid profile, insulin resistance and vasomotricity, and the interaction between these factors, in postmenopausal women receiving hormone therapy. METHODS A prospective, randomized, double-blind study was carried out in which 77 postmenopausal women received one of the three treatment regimens: (A) 2mg oral micronized estradiol (E2) (n=25); (B) 2mg oral E2+1mg oral norethisterone acetate (NETA) (n=28); or C) placebo (n=24), daily for 6 months. Evaluations were carried out at baseline and at the end of treatment on lipid and lipoprotein profiles, homeostasis model assessment of insulin resistance (HOMA-IR) and pulsatility index (PI) of the internal carotid artery by Doppler ultrasonography. RESULTS Mean increases of 15.6% and 2.4% and a reduction of 6.4% in high-density lipoprotein (HDL) levels were found for the E2, E2+NETA and placebo groups, respectively. Reductions of 9.5% and 3.7% and an increase of 12.1% in low-density lipoprotein (LDL), and reductions of 20.0% and 3.8% and an increase of 28.8% in the LDL:HDL ratio were found for the E2, E2+NETA and placebo groups, respectively (p<0.001 in all cases). Insulin levels and HOMA-IR decreased 12.8% and 12.3% in the E2 group and increased 12.9% and 16.0% in the E2+NETA group (p<0.05), respectively. Carotid PI following treatment was 1.18+/-0.23, 1.38+/-0.20 and 1.41+/-0.21 for the E2, E2+NETA and placebo groups, respectively (p=0.0006). CONCLUSIONS Oral estrogen therapy led to an improvement in lipid profile, insulin resistance and carotid blood flow, which was cancelled when NETA was associated.

Effects of estrogen therapy on microalbuminuria in healthy post-menopausal women.

Objective. To evaluate the impact of estrogen therapy on microalbuminuria levels in healthy post-menopausal women. Methods. Sixty post-menopausal women were evaluated in a prospective, randomised, double-blind, placebo-controlled study. The patients were randomly allocated to one of two groups to take one pill orally per day containing either 1 mg of 17β-estradiol (E2 group) or placebo (placebo group). Prior to initiating treatment and at the end of the sixth treatment month, microalbumin was measured in a 12-h urine sample, and lipid profile (total cholesterol, HDL, LDL and triglycerides) and fasting glucose were evaluated. Comparative intra- and inter-group analyses between the initial and final laboratory parameters were performed using the t-test for paired samples and for independent samples, respectively. Results. Microalbuminuria levels remained within normal limits throughout the study and no statistically significant differences were found in the intra- or inter-group analyses. With respect to lipid profile, alterations characteristically encountered during use of estrogen replacement therapy were found. No statistically significant variation in glucose levels occurred during the study period. Conclusion. Estrogen replacement therapy had no significant effect on microalbuminuria levels in healthy post-menopausal patients.

Women's knowledge of health effects of oral contraceptives in five Brazilian cities

BACKGROUND Although acceptability of combined oral contraceptives (COCs) is widespread, patients are often unaware of the noncontraceptive benefits. STUDY DESIGN An opinion survey through telephone interview was conducted to evaluate the knowledge of 500 Brazilian women 15-45 years of age who were current users or had recently used COCs. Data were obtained on their knowledge of adverse events, the effects of COCs on health- and menstrual-related symptoms, noncontraceptive benefits and aspects related to sexual response. RESULTS Most of the women interviewed learned about the pill from doctors or the Internet. Other than the pill, the best-known contraceptive methods were the condom and intrauterine device. The majority of women believe that COCs do not change the risk of gynecological cancers. Most believed that they had no significant effect on sexual response. CONCLUSIONS COCs users in Brazil lack precise information on aspects related to general health, particularly menstrual-related symptoms and noncontraceptive health benefits.

Effects of estrogen and estrogen-progestogen therapy on homocysteine levels and their correlation with carotid vascular resistance.

Objective. To evaluate the correlation between homocysteine levels and carotid vascular resistance in menopausal women submitted to estrogen and estrogen–progestogen therapy. Methods. Eighty-six women with a mean age of 52 years were enrolled in a prospective, randomized, double-blind, 6-month study. Patients were allocated to use one of three oral therapies: placebo (n = 26), micronized estradiol 2 mg/day (n = 30) or micronized estradiol 2 mg/day plus norethisterone acetate 1 mg/day (n = 30). Evaluation of homocysteine levels and Doppler sonography of the common carotid artery, used to calculate pulsatility index (PI), were carried out prior to initiating therapy and at the end of the study. The correlation between these two parameters was evaluated using Pearsons coefficient of correlation. Results. There was a significant reduction in homocysteine levels in the groups treated with estrogen alone or estrogen combined with norethisterone. PI was significantly lower only in users of estrogen alone; however, no significant correlation was found between homocysteine measurements and PI. Conclusion. No significant correlation was found between homocysteine levels and carotid vascular resistance following hormone therapy.

What is the influence of hormone therapy on homocysteine and crp levels in postmenopausal women

OBJECTIVE: To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women. METHODS: In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol), Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate) and Group C received a placebo (control). The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy. RESULTS: After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels. CONCLUSION: Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin) may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels.

Is lipid profile determination necessary in women wishing to use oral contraceptives

INTRODUCTION Although coronary heart disease in users of combined oral contraceptives (COCs) is rare, one of the principal risk factors for its occurrence is dyslipidemia. OBJECTIVE To evaluate the prevalence of dyslipidemia in women wishing to use COCs, and its association with known clinical risk factors in order to evaluate the need to determine the lipid profile in this population. STUDY DESIGN Cross-sectional study involving 516 women aged 18-40 years, 54% nulligravid, who wished to use COCs and presented no contraindications. Dyslipidemia was classified according to the National Cholesterol Educational Project Adult Treatment Panel III guidelines, which define levels of total cholesterol ≥ 200 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, triglycerides >150 mg/dL, and low-density lipoprotein cholesterol ≥ 160 mg/dL as an abnormal lipid profile. The lipid profile was determined, and the association between clinical risk factors and the presence of dyslipidemia was evaluated by the chi-squared test and logistic regression. The receiver operating characteristic curve was constructed to compare body mass index (BMI) and smoking relevance for dyslipidemia. RESULTS The prevalence of dyslipidemia was 33.9%. Smoking and BMI were significantly associated with the presence of dyslipidemia, with sensitivity of 31.3-54% and specificity of 41.9-67.7% for diagnosis of dyslipidemia, respectively. CONCLUSION The high prevalence of dyslipidemia could justify lipid profile evaluation before prescribing a COC. BMI and smoking represent modest predictive markers for the presence of dyslipidemia in candidates for the use of combined oral contraceptives.

Transvaginal ultrasonography assessment of ovarian volumes in postmenopausal women

The authors evaluated ovarian volumes by transvaginal ultrasonography at different periods after menopause. Ninety-eight postmenopausal women with an average age of 51.9 years and a one- to eight-year postmenopausal period were studied. The control group consisted of 40 women during menacme with an average age of 31.8 years, who were also submitted to transvaginal ultrasonography to evaluate ovarian volume. There was no significant difference between right and left ovarian volumes in the study groups. There was a significant decrease in measure and standard deviations of the volumes after the first year of menopause (mean volume--2.2 +/- 0.9 cm3) when compared to the control group (mean volume--6.3 +/- 2.0 cm3), followed by a slow and gradual shrinking after this phase. Decrease in ovarian volume became significant after the fourth postmenopausal year. Transvaginal ultrasonography demonstrated great importance as an investigative method of ovarian diseases in postmenopausal women.

Irregularidades menstruais: inter-relações com o psiquismo

Data from both animal and human research indicate that psychological stress is associated with altered menstrual function. A number of studies have examined the relationship between more common stressors (job strain, financial worries, daily hassles) and menstrual cycle characteristics, such as cycle length and quality of bleeding, as well as amenorrhea. Numerous investigators have suggested that functional reproductive deficits result primarily from direct actions of the hypothalamic-pituitary-adrenocortical, probably modulated by a CRH-stimulated increase in the opioid beta-endorphin. The characterization of the psychic envolvement in these conditions represents basic element for the adequate therapeutical approach.