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Contraception. 2009 Oct; 80(4):325-6.This commentary discusses women with liver diseases and the considerations that are necessary when choosing the appropriate contraceptive method due to the effect of hormones on the liver. It provides recommendations provided by the World Health Organization expert Working Group on family planning guidance to assist those women with their contraceptive options.
Geneva, Switzerland, WHO, 1981. 76 p. (WHO Technical Report Series No. 657)This report on the effect of female sex hormones on fetal health and development aimed to evaluate research on the specific types of sex hormones and their uses, to determine their safety with respect to fetal development and infant health, and to recommend further research in these areas. Theoretically, sex hormones can affect any stage of fetal development. Sex hormones appear to act by promoting synthesis of messenger ribonucleic acid (mRNA) in target tissues, so that research should focus on the specific proteins formed under the direction of newly synthesized mRNA to elucidate potential morphological and physiological effects of exogenous hormones. Following are some research avenues: cytogenetic research, microscopic and macroscopic examination, observations on births and later life, animal teratology, and epidemiological studies. Epidemiological studies not only help elucidate causal associations but also provide public health data. Studies of sex hormones and fetal development and infant health must be free of bias and often suffer from problems of defining pregnancy outcome. Also sex steroids are frequently administered at the same time as other drugs, leading to confounding effects of drug interactions. In order to assess existing data, it is necessary to disaggregate the data from different reports and then to regroup them according to the indications for use, i.e., infertility, contraception, pregnancy testing, supportive therapy during pregnancy, contraception during pregnancy, contraception during breast feeding. Likewise data must be disaggregated according to different types of exposure, i.e., preconception or postconception. The bulk of this monograph is spent disaggregating study data based on the above-stated rationales. The following recommendations are made for indications for use of sex hormones: 1) they should not be used as pregnancy tests; 2) diethylstilbestrol should not be prescribed to a suspected pregnant woman; 3) benefits of progestin therapies must first be proven before they can be recommended for use in supporting pregnancy; 4) oral contraceptives given before pregnancy seem to have no effect on subsequent pregnancy; and during lactation combined therapy should not be given.
[Contraception via a vaginal hormonal ring] Kontratseptsiia posredstvom vlagalishten khormonalen prusten.
AKUSHERSTVO I GINEKOLOGIIA. 1991; 30(1):49-52.Research on the hormonal vaginal ring began in the US in 1973. Its prototype with a diameter of 55 mm releasing in even doses small amounts of hormone was introduced 17 years later. Its high effectiveness with a failure rate of 3-4 pregnancies/100 woman use years is similar to that of most IUDs. The first type contains a combination of estrogen-gestagen consisting of levonorgestrel and 17-beat-estradiol as in oral preparations. It has to be used from the beginning of the menstrual cycle for 3 weeks and removed for 1 week. The second one, devised by a special program of WHO, contains gestagen only in the form of levonorgestrel (LNG) releasing 20-25 mcg of LNG daily. The third type contains progesterone only which is suitable for use by lactating women, as the progesterone eventually absorbed in the maternal system does not pose any risk to the nursing child. At present its effectiveness is being tested, and then its practical application will be examined. The introduction of the prototype was delayed by 2 years when initial investigations showed that the substance used for polymerization of the plastic used for the vaginal ring was carcinogenic, however, this was refuted in subsequent investigations. The vaginal ring is already sold regularly in Great Britain and in some western European countries. This new method allows doctors to provide an alternative contraceptive in addition to the existing ones.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1992; (22):8.The WHO Special Programme on Research, Development and Research Training in Human Reproduction and diagnostic companies conduct research into the development of a simple, accurate, robust, home based method which predicts ovulation. A prolonged rise in the excretion product of estradiol in the uterine indicates that ovulation will soon follow A similar rise in serum estradiol levels also occurs several days before ovulation. Researchers in Melbourne, Australia have created an uncomplicated tool to measure the most plentiful estradiol excretion product, estrone glucuronide, and the progesterone excretion product, pregnanediol glucuronide, whose rising levels indicate the end of the fertile period. In 1991, WHO and the Australian researchers began a multicenter studying comparing this instrument with the sign and symptoms observed in traditional natural family planning methods. As of mid 1992, results were not yet available. The ability to determine the beginning and the end of the fertile period makes this potential tool especially promising. WHO is supporting another multicenter study testing for a decline of the enzyme guaiacol peroxidase in cervical mucus as a marker of approaching ovulation. It is difficult to test for forthcoming ovulation in premenopausal women, because they do not always ovulate their menstrual cycles. A WHO study looked at the association between ovarian hormone secretion an symptothermal indicators of fertility in 36 premenopausal women (177 menstrual cycles). Around 33% of the women regular menstrual cycles that may have been fertile, around 19% experienced no hormonal changes indicating fertility during their cycles, and the rest of the woman had a combination of both. Further traditional symptothermal markers could not distinguish the 2 different types of cycles.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 111-134A 6-month regimen for managing infertile men and/or women ideally forms 4 stages: 1) history and examination of the couple; 2) confirmation of ovulation, compatibility of sperm and mucus, and seminology; 3) tests for tubal patency; and 4) detailed endocrine tests for abnormalities found in Stages 1-3. Medical history should include emotional stress and work pressures, if any. Ovulation confirmation requires 2 tests combined from these 4: 1) basal body temperature; 2) endometrial biopsy; 3) blood progesterone levels; and 4) urinary pregnanediol. These procedures are outlined in detail, and figures chart body temperature variations and expected progesterone and pregnanediol levels. Assessment of cervical mucus and measurement of sperm penetration combine in vitro and in vivo tests. The Sims-Huhner test (postcoital test), though not standardized, is used to analyze sperm-mucus interaction by quantitative scoring of sperm count and motility. Other in vitro tests are the sperm-mucus match test and the fractional postcoital test (both described). Tubal patency is investigated by tubal insufflation with CO2, hysterosalpingography, endoscopy, and laparoscopy. Additional Stage 4 tests include vaginal cytology and assessment of estrogen and progesterone effects.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 21-71This chapter reviews the hormonal changes which occur during the menstrual cycle. During the last days of the preceeding menstrual cycle, plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) increase. Follicular phase is characterized by gradually increasing estrogens. A few days preceding the LH surge, some little understood changes in estradiol, LH, and 17-hydroxyprogesterone, on one hand, and ACTH, cortisol, and aldosterone, on the other, occur. Evidence indicates that the estradiol peak occurs first, followed by a simultaneous rise and fall in LH and 17-hydroxyprogesterone values. The peak period of LH is about 32-44 hours long, during which time a rise in progesterone levels takes place. Other pituitary and steroid hormones (human chorionic gonadotropin, ACTH, prolactin, testosterine, androstenedione, cortisol, and aldosterone) show elevated levels during the periovulatory period. Ovulation occurs 16-48 hours after LH peak. The period following LH surge is characterized by rapidly increasing levels of progesterone, 17-hydroxyprogesterone, and 20-alpha-dihydroprogesterone, accompanied by moderately increasing estrogen levels to form the typical luteal-phase hormonal pattern. A luteal increase occurs also in levels of several other hormones, ranging from renin activity to angiotension, or from pregninolone to aldosterone. The last part of the luteal phase is characterized by rapidly declining levels of peripheral hormones. The perimenstrual phase around onset of heavy bleeding is characterized by gradually decreasing levels of progesterone, 20-alpha-hydroprogesterone, estradiol, and testosterone, associated with an incipient rise in LH and FSH levels.