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Management of deep infiltrative endometriosis (DIE) causing gynecological morbidity: A colorectal surgeon's perspective
Published in Seema Chopra, Endometriosis, 2020
Not all patients are candidates for medical therapy. Patients who are severely symptomatic are probably better served by surgery. Women who wish to conceive cannot take oral medications, as these have the effect of ovulation inhibition. Commonly used drugs include GnRH analogues, progestins, and aromatase inhibitors. Triptorelin and tibolone have been shown to improve intestinal symptoms and pain in a small series [39].
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
The patch, like other combined hormonal contraception, works primarily through ovulation inhibition by hormonal suppression of gonadotropins.17 Because transdermal contraception has the same mechanism of action, it should be given the same considerations for contraindications and non-contraceptive benefits as with COCs. Breast discomfort may be greater than with COCs in the first two cycles of use.7 Because there is not a need for daily administration, the patch can be an excellent option for adolescents.
Progestogen-only methods
Published in Sarah Bekaert, Alison White, Integrated Contraceptive and Sexual Healthcare, 2018
Sarah Bekaert, Alison White, Kathy French, Kevin Miles
Implanon exerts its contraceptive effect by progestogenic means: ovulation inhibitionmucus formation at the cervixaltering the endometrium to make it non-receptive to implantation.
Drospirenone 4 mg-only pill (DOP) in 24+4 regimen: a new option for oral contraception
Published in Expert Review of Clinical Pharmacology, 2020
Maria Chiara Del Savio, Riccardo De Fata, Fabio Facchinetti, Giovanni Grandi
Unlike combined hormonal contraceptives (CHCs), the contraceptive efficacy of POPs was originally based mainly on mechanisms other than ovulation inhibition. This was true for the first and second generations of progestins. With the release of POPs containing DSG (third generation, 75 µg), the ovulation rate dropped from canonical 30–40% to 1–2%. This POP was compared to DRSP-only pill in a randomized trial [30], in which 64 volunteers, randomized into two groups of 32, were followed for two 28-day cycles. The primary objective of the study was to compare the contraceptive efficacy of POP and DRSP-only pill by evaluating contraceptive mechanism of action, such as their ovulation inhibition rates based on follicular diameter, E2 and progesterone levels combined in the Hoogland score. According to the Hoogland score, ovulation is defined as follicle rupture with a subsequent progesterone concentration > 5 nmol/l: the lower the Hoogland score, the more ovulation is suppressed. Both groups achieved ovarian suppression, confirmed by the fact that ovulation did not occur until 9 days after the end of the treatment cycle. The maximum Hoogland score in each treatment group was 4 in cycle 1, while in cycle 2, one subject in each treatment group scored 6. In both cycles, the proportion of subjects who scored 4 was lower in the DRSP group (24/4 regimen) than in the DSG group (continuous regimen). During both treatment cycles, E2 levels were lower in the DRSP group than in the DSG group, reflecting stronger ovarian suppression. The mean E2 levels in cycles 1 and 2 were around 184 pmol/L in the DRSP group in comparison to 255 and 375 pmol/L in the DSG group. The maximum progesterone levels were low (below 11 nmol/L) and did not meet the Landgren criteria for normal ovulation (progesterone level >16 nmol/L for at least 5 days) for both treatment groups.
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
As mentioned, new preparations contain much higher dosages of the progestin, are ending a trend to ‘the lowest possible dose’ that prevailed until the end of the XX century. Today, the prevailing considerations are not ‘the quantity’; rather, they are the ‘pharmacodynamic effects’ and the ability to ensure proper ovulation inhibition.