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Colorectal Surgery for Deep Endometriosis Infiltrating the Bowel
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Hanan Alsalem, Jean-Jacques Tuech, Damien Forestier, Benjamin Merlot, Myriam Noailles, Horace Roman
For women who do not desire immediate pregnancy, postoperative medical therapy to suppress endometriosis is generally advised and is the practice of the authors, despite limited supporting evidence in deep endometriosis. The typical regimen offered includes hormonal suppression with combined hormonal contraceptive pills because of ease of access, low cost and provision of contraception. The European Society for Human Reproduction and Embryology advocates for postoperative use of combined hormonal contraception or a levonorgestrel intrauterine device (Lng IUD) for at least 18–24 months for secondary prevention of endometriosis-associated dysmenorrhea. On the other hand, women who desire pregnancy must receive appropriate counseling and treatment to attain pregnancy as soon as possible (32).
Robotic Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Cela Vito, Braganti Francesca, Malacarne Elisa
Several therapies have been developed for the medical treatment of uterine fibroids, both as exclusive therapy and as preoperative ones. The potential benefits of preoperative medical treatment are to correct anemia before surgery and to decrease intraoperative blood loss and the possibility of reducing fibroid size. However, these agents could make removal of myomas more difficult and may increase the risk of persistent myomas [32]. The most used drugs are combined hormonal contraceptive, progestational agents, gonadotropin-releasing hormone agonists, and selective progesterone receptor modulators (ulipristal acetate) [25, 32, 33]. Athough, with increasing concerns regarding the safety of Ulipristal acetate, it is not recommended to be used for fibroid management.
Late Effects of Treatment for Childhood Brain and Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Ralph Salloum, Katherine Baum, Melissa Gerstle, Helen Spoudeas, Susan R. Rose
Girls can be treated with conjugated estrogen tablets, ethinyl estradiol, estrone sulfate, or transdermal estradiol patches.105,107 The estrogen dose should be increased gradually over 2–4 years.105,108 Progesterone can be added (prior to or after menarche but after substantial breast development).102,105 Premature addition of progesterone can interfere with optimal breast development. Progesterone is cycled using either medroxyprogesterone at 5–10 mg or micronized progesterone at 100–200 mg for 10–14 days. Progesterone withdrawal every 3 months is adequate for long-term endometrial protection.105 At adult height, estrogen replacement may be achieved with combined hormonal contraceptive pills or estrogen patches plus progesterone. Transdermal estradiol is preferable to pills in adolescents, providing physiologic estradiol levels and better effects on lipids, blood pressure, BMD, and uterine growth.105 Combined hormonal contraceptives provide more steroid hormone than needed for replacement (thus are not recommended as first-line therapy), but are often preferred by adolescents as convenient.109 In view of the 5–10% chance of conceiving in patients with primary ovarian insufficiency, patients should be advised to use barrier contraception or intrauterine devices.107
Vitamin D and green tea extracts for the treatment of uterine fibroids in late reproductive life: a pilot, prospective, daily-diary based study
Published in Gynecological Endocrinology, 2022
Giovanni Grandi, Maria Chiara Del Savio, Chiara Melotti, Lia Feliciello, Fabio Facchinetti
Diagnosis of UF of ≥3 cm in location intramural (IM) or subserosal (SS) or several UFs of different sizes, even smaller but with a total diameter ≥3 cm <10 cm, diagnosed by transvaginal ultrasound (TV-US). Women with further concomitant organic causes of AUB (polyps, adenomyosis or suspected of hyperplasia/malignancy) according to the classification revised by International Federation of Gynecology and Obstetrics (FIGO) PALM-COEIN [17] have been excluded.Age ≥40 years old with regular menstrual cycles (cycle length between 25 days and 35 days) until menopausal transition according to principal criteria of Stages of Reproductive Aging Workshop (STRAW) [18].Not using other concomitant hormonal treatments (gonadotropin-releasing hormone analogues, levonorgestrel intrauterine system, combined hormonal contraceptive, ulipristal acetate).
Analysis and new contraception frontiers with combined vaginal rings
Published in Gynecological Endocrinology, 2020
Patricio Barriga Pooley, Andrea Von Hoveling, Guillermo Galán, Jorge López Berroa
Vaginal rings are a proven and interesting alternative of administration of a combined hormonal contraceptive method [1]. The advantages of this administration route include a constant and steadily over-time hormonal release, as well as minimizing the hepatic first pass metabolic impact when compared to the combined oral contraceptives (COCs) [1]. As a direct consequence of the steroids vaginal release, favorable effects are obtained, such as the control of the cyclic bleeding pattern, which makes it possible to use lower systemic doses of ethinylestradiol (EE) and potentially decrease the probability of occurrence of some estrogen-dependent adverse effects [1]. Over the years, different types of vaginal rings have been evaluated in terms of their structure, size, polymers used in their composition and hormonal derivatives they contain [1]. Current formulations contain etonogestrel and EE, as discussed in the following section [1].
Tranexamic acid in gynecologic surgery
Published in Current Medical Research and Opinion, 2020
Andrew Zakhari, Ari Paul Sanders, Meir Jonathon Solnik
Reversible visual disturbances, including altered colour perception and temporary blindness, have been reported with tranexamic acid.70,71 For this reason, acquired defective color vision has been listed as a contraindication in the product monograph, as this prevents detection of a potential early sign of toxicity. The exact mechanism between TXA use and visual disturbances, however, remains to be fully elucidated. Additionally, other contraindications include hypersensitivity, active intravascular clotting, thromboembolic disease, and concomitant use of combined hormonal contraceptives. Overall, TXA is generally well tolerated by patients, with the most frequently reported adverse events being nausea, vomiting, or other gastrointestinal disturbances.72