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Estrogen treatment for senile dementia-Alzheimer’s type
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
H. Honjo, M. Urabe, K. Iwasa, T. Okubo, H. Tsuchiya, N. Kikuchi, T. Yamamoto, S. Fushiki, T. Mizuno, K. Nakajima, M. Hayashi, K. Hayashi
Estrogen treatments cause uterine bleeding even in 71% of older women4. To reduce uterine bleeding and to inhibit estrogen-induced tumors, we administered estrogen in combination with progestogen: CE (1.25 mg/day) was given for 7 weeks to 13 women with AD, and 2.5 mg/day of medroxyprogesterone acetate was added during the 4th to the 7th week. The scores in HDS-R and NSD were increased (improved, p< 0.05) in the 3rd week, but slightly decreased in the 6th week compared with the 3rd week. Breakthrough bleeding occurred in eight patients (62%, 83.4 ± 6.5 years, Mean ± SD) and withdrawal bleeding occurred in three patients (86.0 ± 3.6 years). No bleeding was noted in two patients (80 and 90 years). There was no significant difference between patients due to age. Uterine bleeding occurred in 11 of 13 patients (85%) which was not significantly different from the 71% shown previously.
Adolescent contraception
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Hanna Goldberg, Jasmine Multani, Sari Kives
Breakthrough bleeding may be the most common reason for discontinuation of DMPA, particularly in the adolescent. Irregular bleeding may occur in as many as 25%–50% of users in the first 6–12 months of dosing. Counseling is therefore paramount at the time of prescribing DMPA. Increasing the DMPA dose and shortening the interval between doses are no longer recommended.33 Rather, if breakthrough bleeding persists beyond 3–6 months, other causes should first be investigated.33 Therapeutic options for irregular bleeding include supplemental estrogen, such as 0.625–1.25 mg of conjugated equine estrogen (CEE) per day for 28 days, 1–2 mg of 17β-estradiol per day for 28 days, or transdermal 17β-estradiol per day for 25 days. Additionally, administration of a nonsteroidal anti-inflammatory drug (NSAID) twice daily for 5 days, adding an oral contraceptive pill for 1–3 months, and administration of tranexamic acid (500 mg twice daily) for 5 days may be considered.33 Unfortunately, none of these methods is completely satisfactory; fortunately, amenorrhea occurs in 55%–60% of DMPA users at 12 months66,69,87–89 and up to 68% of DMPA users at greater than 1 year. Many teenagers perceive this as an appealing feature of the medication, which may contribute to their compliance.
Sports and Physical Activity for Women and Girls
Published in James M. Rippe, Lifestyle Medicine, 2019
As previously mentioned, unexpected breakthrough bleeding related to contraceptive use can be embarrassing to an athlete in competition, and bleeding-related symptoms such as cramping and bloating can negatively impact performance. Breakthrough bleeding is common when initiating hormonal contraceptive therapy, most significantly with the use of combined oral contraceptive pills and depot medroxyprogesterone, and typically diminishes after 3–4 cycles. Amongst pill users, lack of adherence to the prescribed medication is the most common cause of breakthrough bleeding – specifically, skipping pills, taking pills late, taking other medications or using herbal supplements, and smoking tobacco. Patients with irregular bleeding are 60–70% more likely than those without bleeding to have missed two or more pills in a pill pack.43 While most women want the lowest amount of hormone possible to provide adequate protection from pregnancy, prescribers should also be aware that the amount of hormone contained within combined oral contraceptive pills also influences the rate of breakthrough bleeding. Users of pills containing only 20 micrograms of ethinyl estradiol have 2.5 times higher rates of breakthrough bleeding compared to females taking pills with greater than 20 micrograms of ethinyl estradiol.44
Hysterical Solidarity: An Embodied Reflection on Contemporary Sexual and Reproductive Rights Concerns in the United States
Published in Studies in Gender and Sexuality, 2023
My own experiences of anxiety, chronic fatigue, mood lability preceding menstruation, and intense pelvic pain correspond with many of the commonly known symptoms of endometriosis, but in trying to make sense of them, I often doubt myself. Is this pain as bad as it seems to me, or am I being hysterical? When I first learned about endometriosis, I immediately associated it with hysteria—what else could possibly encapsulate the mysterious nature of traveling tissue or wandering wombs? The roots of hysteria are in ancient Egypt and Greece. The Eber Papyrus (Book of the Heart) and Corpus Hippocraticum (Hippocrates’ body of work) both describe hysterical symptoms using the image of an out-of-control reproductive organ: The uterus wanders through the body, making hysteria sufferers anxious, neurotic, prone to seizures, easily fatigued, and weak (Durns, 2022). The more I thought about my own endometrial dysfunction, the more frustrated I became. My lack of control over a routine bodily function felt, to me, crazy-making. Breakthrough bleeding, debilitating cramps, bloating, and fatigue have plagued me at least once a month for nearly two decades of my life, and yet I still wonder if maybe I’ve exaggerated the whole thing. Am I just another hysterical patient? Is it all in my head?
Localized, on-demand, sustained drug delivery from biopolymer-based materials
Published in Expert Opinion on Drug Delivery, 2022
Junqi Wu, Sawnaz Shaidani, Sophia K. Theodossiou, Emily J. Hartzell, David L. Kaplan
Nearly 80% of women from high-income countries have reported using oral hormonal contraceptive pills [32]. These hormones include androgens, estrogens, and/or progesterone. Combination pills that include both estrogen and progestin are associated with breakthrough bleeding, a twofold risk of myocardial infraction and stroke and a 37 times higher risk of venous thrombosis [32,33]. Additionally, contraceptive pills must be taken daily, leading to decreased patient compliance and drug effectiveness if the user forgets to take or misplaces the pills. Subdermal implants that achieve sustained, long-term systemic release of contraceptives were created to address these issues [34]. Nexplanon is an etonogestrel-releasing ethylene vinylacetate copolymer rod-shaped implant inserted subdermally in the arm, and can be left in place for 3 years via surgical incision [35]. If the patient sustains injuries near the implant site, however, the implant could be damaged and may require surgical removal [36]. Additional side effects associated with systemic subdermal contraceptives include menstrual disturbances, acne, headache, abdominal pain, hair loss, weight gain, and follicular cysts [34]. Currently, the most popular local contraceptive delivery systems are intrauterine devices (IUDs), which are used by more than 168 million women worldwide. However, IUDs also have complications such as causing infections, pelvic inflammatory disease, uterine perforation, and menstrual disturbances [37,38].
Breakthrough bleeding episodes in pediatric severe hemophilia a patients with and without inhibitors receiving emicizumab prophylaxis: a single-center retrospective review
Published in Pediatric Hematology and Oncology, 2022
Eman Hassan, Jayashree Motwani
Emicizumab decreased the number of bleeding events and improved the quality of life of PwHA.8 However, breakthrough bleeding episodes can still occur, and additional treatment with either rFVIII or BPAs may be required, depending on the inhibitor status. In our cohort of patients, 56.8% (29/51) of patients had zero bleeding events, 29.4% (15/51) had minor bleeds requiring antifibrinolytic agents, and 19.6% (10/51) received additional rFVIII administration. Eight patients received factor treatment for either joint pain or prevention of bleeding after trauma without confirmation of bleeding. We recommend that treatment of similar events be decided by the treating clinician in the hospital, and treatment should only be given at home in emergencies and not for all presumed bleeds/pains to avoid unnecessary exposure to rFVIII. It was noted that most of the patients who experienced nose bleeds had not had similar episodes prior to starting emicizumab. This finding should be reviewed in future studies. Another interesting finding was that one patient’s hematuria spontaneously resolved without additional hemostatic agents. Since many of our patients started on emicizumab during the COVID-19 pandemic, we expect that the overall incidence of bleeding might increase after resuming their full physical activities. Therefore, we believe that continuous monitoring of patients on emicizumab is important to confirm the long-term efficacy of this novel agent.