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Venous Thromboembolism and Anticoagulation
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Combined estrogen-progestin oral contraceptives have been associated with higher efficacy than progestin only pills, but have the disadvantage of an increased risk of VTE. This risk has been attributed to the estrogen component. In women taking estrogen-containing oral contraceptives the risk of VTE increases 39-fold to 99-fold among those heterozygous for factor V Leiden and prothrombin G20210A mutations [126]. A meta-analysis of eight observational studies assessing the risk of VTE in women prescribed progestin-oral contraception showed no increased risk compared with non-users of hormonal contraception [127]. In a sub-analysis of women prescribed injectable progestins, there was a two-fold increase in thrombotic risk. The type of progestin might influence this risk, with newer progestins such as desogestrel, gestodene, and norgestimate associated with a greater risk than older ones such as levonorgestrel, lynestrenol, and noresthisterone [128–130]. The risk of VTE of the general population increases two- to three-fold in users of CEPCs (combined estro-progestin contraception) with norethisterone, levonorgestrel, or norgestimate, and of six-fold in users of CEPCs containing desogestrel, gestodene, drospirenone, or cyproterone acetate [131].
Immunology of pre-eclampsia
Published in Pankaj Desai, Pre-eclampsia, 2020
Uterine gland knockout (UGKO) epithelial cells has proven to be useful in the understanding of the foetoplacental unit in early pregnancy. Understanding UGKO has come from experiments in pregnant ewes. It has been found that the epithelial cells and their secretory activities can be efficiently blocked by progestins. The hypothesis that progestins can block the uterine glandular activity was tested by Bartol et al. in 1988.7 They exposed ewes to norgestimate, a potent synthetic progestin, from their birth to postnatal day 13 and found that the uterine adenogenesis was successfully inhibited. Exposure of the neonatal ewes to norgestimate did not hamper the gross development of Müllerian system. Additionally, norgestimate did not affect the development of the brain or the hypothalamo-pituitary-ovarian axis, but it decisively blocked the development of the glandular component in the endometrium. This resulted in infertility or subsequent miscarriages in the ewes. Results from these studies explained the critical role of uterine glands in the secretion of uterine milk and a subsequent healthy pregnancy outcome.
Combined methods
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Evra releases 150 micrograms of norelgestromin and 20 micrograms of ethinylestradiol per 24 hours; norelgestromin is the primary active metabolite of norgestimate (the progestogen contained in the combined pill Cilest). Evra is a transdermal patch which lasts seven days. A patch is used for three weeks, changed each week with a new patch and followed by a hormone-free interval of seven days in the fourth week where a withdrawal bleed occurs. Evra prevents pregnancy by inhibiting ovulation, altering cervical mucus so that it is impenetrable to sperm and by making the endometrium unfavourable to implantation.
Emerging drugs for the treatment of acne: a review of phase 2 & 3 trials
Published in Expert Opinion on Emerging Drugs, 2022
Siddharth Bhatt, Rohit Kothari, Durga Madhab Tripathy, Sunmeet Sandhu, Mahsa Babaei, Mohamad Goldust
Hormone-based therapies are effective in females with acne associated with hormonal imbalances. It is postulated that the antiandrogenic effects of hormonal contraceptives lead to decreased sebaceous activity. Currently, four combination oral contraceptives are approved by FDA for use in post-menarcheal females – Ethinyl estradiol and norgestimate (for those 15 years of age and older); Ethinyl estradiol, norethindrone acetate, and ferrous fumarate (for those 15 years of age and older); Ethinyl estradiol and drospirenone (for those 14 years of age and older); and Ethinyl estradiol, drospirenone, and levomefolate (for those 14 years of age and older). According to a meta-analysis oral antibiotics are superior to oral contraceptives at 3 months but equivalent to it at 6 months [6]. While prescribing contraceptives, the acnegenic effects of progesterone-containing contraceptives should be kept in mind. Also, the risk of thromboembolism should be considered especially in smokers. Potassium-sparing diuretics like spironolactone are also used in doses as low as 50 mg OD owing to their anti-androgenic action. The risk of teratogenicity should always be considered while prescribing this drug.
Acute pulmonary embolism after arthroscopic glenoid labral repair and subacromial decompression: case report and review of the literature
Published in The Physician and Sportsmedicine, 2018
Michelle Yagnatovsky, Amos Z Dai, Michael Zacchilli, Laith M Jazrawi
In addition to PCOS itself being a risk factor for VTE, the mainstay of treatment for PCOS – combined OCs – compounds this risk. Our patient was on a combination of norgestimate and EE. The increased risk of VTE in combined OC users is well established [40–42]. Weill et al. recently conducted a study on 5 million French women showing that for the same progestin, a lower dose of 20 µg of estrogen versus 30–40 µg was associated with a lower incidence of PE [43]. EE strongly affects liver proteins and may change procoagulation and fibrinolytic balance [44,45]. These hepatic effects are related to EE’s chemical composition. The 17-alpha-ethinyl group is attributed to slow metabolism and long tissue retention [45,46]. Rosseland et al. found women with PCOS who were not taking OCs had 1.5 times the risk of developing a DVT as compared to their matched controls, and those women with PCOS on OCs had twice the risk as compared to their matched controls [47].
Pharmacodynamics of combined estrogen-progestin oral contraceptives 3. Inhibition of ovulation
Published in Expert Review of Clinical Pharmacology, 2018
Carlo Bastianelli, Manuela Farris, Elena Rosato, Ivo Brosens, Giuseppe Benagiano
Norgestimate has also been utilized in triphasic combinations. An early, large, open-label, clinical trial was conducted to compare triphasic regimens with LNG/EE and NGM/EE [108]. Within this trial a small study evaluated inhibition of ovulation with the triphasic NGM/EE combination. Ovulation suppression was documented through the presence of significantly lower levels of LH, FSH, E2, and P. These results were later confirmed in another comparative study [109].