A contraceptive subdermal implant releasing the progestin S1-1435: ovarian function, bleeding patterns, and side effects*t

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "A contraceptive subdermal implant releasing the progestin S1-1435: ovarian function, bleeding patterns, and side effects*t"

Transcription

1 FERTILITY AND STERILITY Vol. 58, No.6, December 1992 Copyright CI 1992 The American Fertility Society Printed on ocid-free paper in U.S.A. A contraceptive subdermal implant releasing the progestin S1-1435: ovarian function, bleeding patterns, and side effects*t Marjut Laurikka-Routti, M.D.:j: Maija Haukkamaa, M.D., Ph.D. City Maternity Hospital, and Steroid Research Laboratory, Department of Medical Chemistry, University of Helsinki, Helsinki, Finland Objective: To study ovarian function, bleeding patterns, and side effects during the I-year use of a new modified contraceptive subdermal implant releasing the progestin ST-1435 with a lifetime of 2 years. Design, Patients: The effect on ovarian function and bleeding patterns of one contraceptive implant releasing the progestin ST-1435 was studied in 26 healthy women who volunteered. Side effects were recorded. Setting: The outpatient clinic of the City Maternity Hospital, Helsinki, Finland. Intervention: One ST-1435 contraceptive implant was inserted subcutaneously into the ventral aspect of left upper arm. Main Outcome Measures: The women attended the clinic at half-year intervals. Records of bleeding were kept. Blood samples were collected from 5 women before insertion of an implant, from 12 women during the first 5 to 6 weeks of use, and from 10 women during the 6th and 12th month of use. Serum concentrations of ST -1435, progesterone, and estradiol were determined. Side effects were reported. Results: The study covered 302 woman-months. The implant gave serum concentrations of ST high enough to inhibit ovulation in all of the 37 analyzed cycles. No pregnancies occurred. Irregular bleeding or spotting was the main event observed, especially during the 1st year of use. One half of the users had irregular cycles. None of the women's implants was removed during 1 year of use because of irregular bleeding. The implant was well accepted and tolerated by the women; no hormonal side effects were reported. Conclusions: One single 4-cm subdermal ST-1435 implant with a lifetime of 2 years showed good contraceptive efficacy and led to suppression of ovulation. No hormonal side effects were reported. Irregular bleeding patterns were common but well-tolerated, and the implant had a high continuation rate. Fertil SterilI992;58:1l42-7 Key Words: Progestin, implant, ST-1435, ovarian function, bleeding, side effects, subdermal Received May 4, 1992; revised and accepted August 26, * This work was undertaken as part of the Contraceptive Development Program sponsored and coordinated by the International Committee for Contraception Research of the Population Council, Inc., New York, New York. t Financial support was provided by the George J. Hecht Fund, The Mellon Foundation, The Rockefeller Foundation, and the United States Agency for International Development through the Population Council, Inc., New York, New York as well as the Paulo Foundation, Helsinki, Finland. The content of this report does not necessarily reflect the policy of any of the funding sources. Steroid-releasing silastic implants inserted subdermally are known to give a constant slow steroid release and can be used for contraceptive purposes. Norplant (Leiras Oy, Turku, Finland) subdermal implants are widely used. This method that uses six implants has a long duration of effectiveness > 5 :j: Reprint requests: Marjut Laurikka-Routti, M.D., Steroid Research Laboratory, Department of Medical Chemistry, University of Helsinki, Siltavuorenpenger 10 A, SF Helsinki, Finland Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST-1435 Fertility and Sterility

2 years (1). Reducing the number of implants would make the insertion and the removal of the contraceptive implants easier; the ideal number would be one implant. Nortestosterone derivatives have steroidal side effects and, depending on the daily dose, could affect circulating lipoproteins (1-3). Therefore the steroid to be used in new implants should, if possible, have a structure that is not associated with these side effects. The progestin ST -1435, a 19-norprogesterone derivate, was synthesized by E. Merck, Darmstadt, Germany (4). This progestin was inactive by the oral route of administration (4) but potent when given in subcutaneous (SC) implants (4-8), intracervically (9), in transdermal gel (10, 11), or in vaginal rings (12). A single implant releasing ST-1435 has been effective in inhibition of ovulation (6, 8, 13) and to have a lifetime of 2 years (8). The progestin has not had androgenic side effects (4,6, 9, 14) and might be used as a contraceptive steroid during lactation (4, 15). The purpose ofthe study was to obtain more clinical experience with a new single subdermal implant releasing ST-1435 with a lifetime of 2 years. We report serum concentrations of ST-1435, ovarian function measured by serum concentrations of progesterone (P) and estradiol (E2), bleeding patterns, side effects, and acceptability during the 1 year of use of the ST-1435 implant. MATERIALS AND METHODS Study Subjects and Implants The study group consisted of 26 healthy volunteers who were between 20 and 36 years of age (28 ± 5 [mean ± SD]) in the beginning of the study. All had regular menstrual cycles before the insertion of the ST-1435 (16-methylene-17a-acetoxy-19-nor-4- pregnene-3,20-dione) implant, and none had used hormonal contraception for at least 1 month before implant insertion. The lifetime of one 4-cm implant containing 78 mg of ST-1435 was estimated to be 2 years, and only one implant was needed for contraceptive purpose (8). The sc implant was inserted into the ventral aspect of the left upper arm between the 1st and 7th day of the menstrual cycle under local anesthesia. The insertion technique was the same as with Norplant and published previously (1, 2). Gynecological examination was done before insertion and every 6 months until removal of the implant. Cervicovaginal smears were also taken from every subject at 1-year intervals. All subjects were asked to keep a record of bleeding. Every 6 months the subjects reported side effects and problems. After the 1st year of implant use, 16 study subjects answered a questionnaire concerning the acceptability and personal side effects of the contraceptive method. Blood Samples and Radioimmunoassay (RIA) Serum samples for the analysis of ST-1435, P, and E2 were obtained from 5 to 12 study subjects at different times. The samples were taken from the arm contralateral to the one in which the implant was inserted. Venous blood samples for the analysis of P and E2 were collected from 5 subjects during the luteal phase of the pretreatment cycle. The serum concentrations of ST-1435, P, and E2 were measured twice a week in 12 study subjects during the first 5 or 6 weeks of use. Six months later samples were collected from 10 subjects and 6 months later from 10 (after 12 months of use). Serum was separated by centrifugation, and samples were stored at -20 C until analyzed by RIA. The serum concentrations of ST-1435 were determined by RIA as described previously (16). The practical detection limit of the assay was 27.8 pmoljl. The intra-assay and interassay coefficients of variation (CVs) in the optimal range of study were 9.3% and 16.1 %. The serum concentrations of P and E2 were measured by RIA using the protocol from the World Health Organization (17). The practical detection limits of the assays were 0.64 nmoljl (P) and 73 pmoljl (E2). The intra-assay CVs in the optimal range of study were 4.0% (P) and 5.5% (E2) and interassays CVs 15% (P) and 11.7% (E2). Wilcoxon's signed rank test was used for statistical analysis. The P values were Bonferroni-corrected and P < 0.05 was considered statistically significant. The values are expressed as means ± SD. RESULTS Serum Concentrations of Progestin ST-1435 and Ovarian Function A total of 302 woman-months of use of the ST implant were recorded. The mean (±SD) concentrations of ST-1435 at 6-month interval are shown in Table 1. The mean concentrations of ST stayed above the minimal range (55 to 139 pmoljl), which is known to inhibit ovulation by ST (13). Interindividual variations were seen in Vol. 58, No.6, December 1992 Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST

3 Table 1 Serum Concentrations ofthe Progestin ST-1435, E 2, and P During the Use of Implant * Time ST-1435t P pmol/l nmol/l 1st month 167 ± 92 (122) 363 ± 177 (105) 1.2 ± 1.4 (126) 6th month 166 ± 61 (116) 303 ± 122 (114) 1.7 ± 0.7 (104) 12th month 138 ± 90 (110) 448 ± 405 (107) 1.4 ± 2.9 (99) * Values are means ± SD with number of samples in parentheses. t 100 pg/ml = 278 pmol/l. ~ 100 pg/ml = 367 pmol/l. 10 ng/ml = 32 nmol/l. ST-1435 concentrations. Estradiol levels fluctuated during the use of ST-1435 implants. Peak values were 1,035 pmoljl at 1 month, 756 pmoljl at 6 months, and 2,195 pmoljl at 12 months. The mean (±SD) concentrations of E2 (Table 1) did not vary during the time of the study. The five control cycles recorded were all ovulatory, and serum P ranged from 19 to 42 nmoljl. All of the analyzed cycles (37 measured treatment cycles) were anovulatory (Table 1). No persistent P elevation above 3.2 nmoljl was noticed, although fluctuation in E2, showing follicular development, was observed. No pregnancies were detected. Bleeding Control Twenty-three users ofthe ST-1435 implant kept bleeding records during the first 6 months of use and 21 during the next 6 months (6 to 12 months). A summary of the subjects' bleeding patterns during the 1 year of use of the ST-1435 implant is shown in Table 2. The cycles were judged as regular if the bleeding occurred every 21 to 35 days and as amenorrhic ifthere were more than 90 days of no bleeding or spotting. All other bleeding patterns were judged to be irregular (Table 2). Irregular bleeding was the most common abnormality reported. About half of the subjects had irregular bleeding or spotting. During the second 6 month-period, there were fewer mean spotting and bleeding days than during the first 6-month period. Episodes of amenorrhea were seen during the 1st year of the study in about one fourth of the subjects. Side Effects and Acceptability The most frequent side effects were bleeding disturbances during the 1st year of implant use. Only a few other side effects were noticed and then only transiently (Table 3). But when 16 study subjects were asked after use for 1 year, only 3 of 10 women with bleeding disturbances considered this as an unacceptable side effect. Eleven of 16 cited ease of Table 2 Bleeding Patterns During the Use of ST-1435 Implant Months No. of women Total bleeding days Total spotting days Bleeding and spotting days ± 2.8 (4.0)* 3.3 ± 3.6 (3.0) 4.3 ± 4.0 (3.0) 5.0 ± 5.5 (3.0) 8.2 ± 5.3 (9.0) 8.3 ± 7.2 (10.0) Months ± 4.1 (3.0) 4.0 ± 4.6 (3.0) 3.1 ± 4.8 (1.0) 2.8 ± 3.4 (2.0) 5.1 ± 3.8 (4.0) 3.1 ± 3.2 (3.0) 2.9 ± 3.4 (2.0) 4.0 ± 5.6 (2.0) 9.3 ± 6.5 (8.0) 7.2 ± 6.4 (5.0) 6.0 ± 7.0 (4.0) 6.8 ± 7.3 (4.0) Months o to 6 7 to 12 Oto 6 7 to 12 No. of women No. of bleeding episodes Total bleeding days Total spotting days Bleeding and spotting days ± 3.2 (6.0) 21 ± 15 (16) 24 ± 18 (21) 45 ± 28 (40) ± 2.9 (6.0) 17 ± 16 (13) 16 ± 15 (10)t 34 ± 26 (28)~ Longest nonbleeding interval (d) Longest bleeding and spotting run (d) Regular cycles Irregular cycles Amenorrhea ± 39 (44) 13.0 ± 7.1 (12.0) ± 50 (67) 8.0 ± 6.5 (6.0) * Values are means ± SD with median in parentheses. t Total spotting days decreased significantly during the second half year (P < 0.05). ~ Bleeding and spotting days decreased significantly during the second half year (P < 0.05) Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST-1435 Fertility and Sterility

4 Table 3 Side Effects During the Use of ST-1435 Implant 6mo Duration of use 12 mo No. of subjects No. of subjects discontinued 1 2 No side effects Bleeding disturbances 10 8 Irregular bleeding 7 7 Oligoamenorrhea 3 1 Depression 2* Mastalgia, transient It It Headache 1* 1* Weight gain 1 * Subjects had this feeling, but they had had it before too. t Different subjects. use as an advantage of this contraceptive method. Two had easier menstruation than before, less dysmenorrhea, and the quantity of bleeding was smaller. Four of 16 subjects noticed no advantages or disadvantages of this contraceptive method. After the 1st year of use of the ST-1435 implant, 6 of 16 users were very satisfied, 7 satisfied, 2 dissatisfied, and 1 could not tell. If this method of contraception were a commercial product, 13 of 16 study subjects would continue the use of the method after the study with a new implant and recommend it to their friends. No infections occurred after insertion (n = 26) or removal (n = 3) of the implants. Gynecological examinations did not reveal any abnormalities. One cervicovaginal smear was class II, but after 6 months it was normal class I. One cervicitis caused by Chlamydia trachomatis was treated during the study. Two of the study subjects requested to have the implant removed so that they could plan a pregnancy (1 after 6 months and the other after 1 year). One other subject asked to have the implant removed after 8 months, citing personal problems. In this case, she clearly had had bleeding disturbances, i.e., irregular cycles, although she had not kept a bleeding record. After 1 year of use, the implant was not removed because of bleeding problems from any of the 26 subjects. The continuation after 1 year of use of the implant was 23 of 26 (89%). DISCUSSION The aim of this study was the development of a single implant method: a second generation implant. The first clinical trials with ST-1435 subdermal implants were done in 1976 (5): 3 or 5 SC implants containing 35 mg of ST each were inserted into 285 women. The lifetime of these implants was 300 days on an average. Only two pregnancies occurred after 11 and 19 months of use, showing the progestin to be highly effective. After these promising results, ST-1435 implants in different lengths have been studied (4, 6, 7, 13, 16). Subcutaneous implants releasing ST-1435 have been shown to effectively inhibit follicle development and ovulation with serum concentrations of ST-1435 in the range of 150 to 300 pg/ml with three implants containing 40 mg ST-1435 each (16) and 50 to 220 pg/ml with one implant (13). When serum ST-1435 concentrations decreased to 50 to 100 pg/ml (139 to 278 pmoljl), the first E2 increase was seen showing the start of follicle development, but P remained low showing inhibition of ovulation (13). Serum levels of ST-1435 constantly above 56 pmoljl were observed to prevent ovulation (13). The serum concentrations of the steroid in the range of 138 to 167 pmoljl (mean) achieved in our study allow follicle function but inhibit ovulation. Ovulation inhibition by ST is achieved via different mechanisms depending on the serum progestin concentrations: high levels inhibit ovulation via both central and direct ovarial mechanism, whereas low doses inhibit only via the central mechanism (the positive feedback of E2 on midcycle gonadotropin surge is abolished, and decreased luteinizing hormone/follicle-stimulating hormone ratio is achieved) (18). Interindividual variations in serum ST-1435 levels were observed in this study as well as in the previous studies using ST-1435-releasing implants and implants releasing megestrol acetate, d-norgestrel, and norethindrone (19-21). It might be partly explained by differences in sex hormone-binding globulin (SHBG) binding capacity between individuals (19) in the case of levonorgestrel and norethindrone, progestins with high affinity to SHBG. But in the case of ST -1435, which is not bound by SHBG or corticosteroid-binding globulin (22), the interindividual differences could be because of differences in hepatic metabolic capacities (23). In previous studies, the exhaustion of implants has been rapid up to 1 year, demanding frequent reinsertion, and the steroid doses have been too high during the first months of use causing hypoestrogenism (4, 6, 7, 13, 16). Now we seem to have an implant with a rather sustained release of steroid at levels that inhibit ovulation but allow follicular de- Vol. 58, No.6, December 1992 Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST

5 velopment and thus do not cause changes in E2 levels, and a single implant method with a lifetime longer than before: 2 years (8). Norethindrone acetate has been tested as a single contraceptive implant, but the pregnancy rate with this progestin was high (24). A single se implant releasing 3-keto desogestrel has been tested in a small trial (8 subjects) (25). All subjects had bleeding abnormalities, and only two subjects continued to the end of the study (1 year). During the use of ST-1435 implants in previous studies, amenorrhea was very common (83% without bleeding over 60 days) (4). But now with a more optimal dose ofthe progestin than before, one fourth of subjects at most had amenorrhea, and at least half of the subjects had regular periods. Very few side effects except bleeding abnormalities have been reported during the use of high doses (120 tt/d) of ST-1435 (6). Eight of 282 subjects had nervousness, 7 headache, 4 decreased libido, but hoarseness and acne occurred in only 1 subject each (6). In our study, no androgenic hormonal side effects were reported, and the few side effects that occurred were transient. According to previous studies, the progestin ST-1435 has not caused the changes in lipid values, typical for androgenic progestins (7, 14). The new contraceptive implant was accepted well. The most frequently observed side effect was excessive bleeding and spotting, which did not cause any removals of implants after 1 year. The continuation rate for the implant was almost 90% after the 1st year. During the use of the implant releasing the high dose of 120 ttg/d of ST-1435 with the lifetime of 6 months and a high continuation rate of 81.4%, 11 of 282 subjects requested discontinuation because of excessive bleeding (6). Twenty-six percent of Norplant implants were removed because of bleeding disturbances after 1 year (3). In conclusion, a single 4-cm subdermal implant releasing the progestin ST-1435 in low doses seems to be an effective contraceptive method. During the use of the implant, concentrations of serum Pare low showing anovulation, but excessive suppression of ovarian function is not seen. Hormonal side effects were not reported. Irregular bleeding patterns are common but well accepted, and the implant has a high continuation rate. REFERENCES 1. Shoupe D, Mishell DR Jr. Norplant: subdermal implant system for long-term contraception. Am J Obstet Gynecol 1989;160: Tikkanen MJ, Nikkilii EA. Oral contraceptives and lipoprotein metabolism. J Reprod Med 1986;31: Olsson S-E, Odlind V, Johansson EDB, Sivin I. Contraception with NorplantR implants and Norplant R -2-implants (two covered rods): results from a comparative clinical study in Sweden. Contraception 1988;37: Odlind V, Lithell H, Kurunmiiki H, Liihteenmiiki PLA, Toivonen J, Luukkainen T, et al. ST-1435: development of an implant. In: Zatunchni GJ, Goldsmith A, Shelton JD, Sciarra JJ, editors. Long-acting contraceptive delivery systems. Philadelphia: Harper and Row, 1984: Coutinho EM, DaSilva AR, Kraft H -G. Fertility control with subdermal Silastic capsules containing a new progestin (ST- 1435). Int J Fertil 1976;21: Coutinho EM, Da Silva AR, Carreira CMV, Sivin I. Longterm contraception with a single implant of the progestin ST Fertil Steril1981;36: Kurunmiiki H, Toivonen J, Liihteenmiiki PLA, Luukkainen T. Contraception with subdermal ST-1435 capsules: side-effects, endocrine profiles and liver function related to different lengths of capsules. Contraception 1985;31: Haukkamaa M, Laurikka-Routti M, Heikinheimo O. Contraception with subdermal implants releasing the progestin ST-1435: a dose-finding study. Contraception 1992;45: Kurunmiiki H, Toivonen J. Liihteenmiiki PLA, Luukkainen T. Intracervical release of ST-1435 for contraception. Contraception 1984;29: Haukkamaa M, Laurikka-Routti M, Heikinheimo O. Transdermal absorption of the progestin ST-1435: therapeutic serum concentrations and high excretion of the steroid in saliva. Contraception 1991;44: Suhonen S, Haukkamaa M, Liihteenmiiki P, Holmstrom T. Endometrial effect of transdermal estradiol and progestin ST-1435 in postmenopausal women. Fertil Steril 1992;57: Laurikka-Routti M, Haukkamaa M, Heikinheimo O. A contraceptive vaginal ring releasing ethinyl estradiol and the progestin ST-1435: bleeding control, serum steroid concentrations, serum lipid and serum chemistry. Contraception 1990;42: Liihteenmiiki PLA, Weiner E, Liihteenmiiki P, Johansson EDB, Luukkainen T. Pituitary and ovarian function during contraception with one subcutaneous implant releasing a progestin, ST Contraception 1982;25: Odlind V, Lithell H, Selinus I, Vessby B. Unaltered lipoprotein and carbohydrate metabolism during treatment with contraceptive subdermal implants containing ST Contraception 1985;31: Liihteenmiiki PLA, Diaz S, Miranda P, Croxatto H, Liihteenmiiki P. Milk and plasma concentrations of the progestin ST-1435 in women treated parenterally with ST Contraception 1990;42: Liihteenmiiki P, Weiner E, Liihteenmiiki PLA, Johansson E, Luukkainen T. Contraception with subcutaneous capsules containing ST Pituitary and ovarian function and plasma levels of ST Contraception 1981;23: Sufi SB, Donaldson A, Jeffcoate SL. WHO special progamme of research: development and research training in human reproduction. Programme for the provision of matched assay reagents for radioimmunoassay of hormones in reproductive physiology. Method Manual. London: Liihteenmiiki PLA, Liihteenmiiki P. Contraception-depen Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST-1435 Fertility and Sterility

6 dent mechanisms of ovulation inhibition by the progestin ST Fertil SterilI985;44: Weiner E, Johansson EDB. Contraception with d-norgestrel SilasticR rods. Plasma levels of d-norgestrel and influence on the ovarian function. Contraception 1976;14: Weiner E, Johansson EDB. Contraception with megestrol acetate implants. Megestrol acetate levels in plasma and the influence on the ovarian function. Contraception 1976;13: Odlind V, Weiner E, Johansson EDB. Plasma levels of norethindrone and effect upon ovarian function during treatment with silastic implants containing norethindrone. Contraception 1979;19: Liihteenmiiki PLA, Hammond GL, Luukkainen T. Serum non-protein bound percentage and distribution of the progestin ST-1435: no effect of ST-1435 treatment on plasma SHBG and CBG binding capacities. Acta Endocrinol (Copenh) 1983;102: Alvan G. Individual differences in the disposition of drugs metabolised in the body. Clin Pharmacokine 1978;3: Bhatnager S, Srivastava VK, Takkar D, Chandra VL, Hingoraini V, Laumas KR. Long-term contraception by steroid releasing implants: a preliminary report on longterm contraception by a single Silastic implant containing norethindrone acetate (ENTA) in women. Contraception 1975;11: Olsson S-E, Odlind V, Johansson EDB. Clinical results with subcutaneous implants containing 3-keto desogestrel. Contraception 1990;42: Vol. 58, No.6, December 1992 Laurikka-Routti and Haukkamaa Contraceptive implant releasing ST

Comparison of vaginal and oral administration of emergency contraception

Comparison of vaginal and oral administration of emergency contraception CONTRACEPTION Comparison of vaginal and oral administration of emergency contraception Eliran Mor, M.D., a Peyman Saadat, M.D., a Sari Kives, M.D., b Emily White, M.D., c Robert L. Reid, M.D., b Richard

More information

OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE

OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE (Drospirenone 3 mg +Ethinyl estradiol 30mcg) Way Past Just Contraception Rasmin - Composition An OC formulation based on drospirenone Each calender pack contains

More information

Female Sexual Hormones Indications and Therapy

Female Sexual Hormones Indications and Therapy Female Sexual Hormones Indications and Therapy In puberty, a woman has about 400,000 ovules, at the age of 40-44 years about 17,000 only. On average, each grown-up woman (still having ovulation) loses

More information

Picking the Perfect Pill How to Effectively Choose an Oral Contraceptive

Picking the Perfect Pill How to Effectively Choose an Oral Contraceptive Focus on CME at Queen s University Picking the Perfect Pill How to Effectively Choose an Oral Contraceptive By Susan Chamberlain, MD, FRCSC There are over 20 oral contraceptive (OC) preparations on the

More information

Product Information. Confidence that lasts

Product Information. Confidence that lasts Confidence that lasts What is Mirena? Inhibition of sperm motility and function inside the uterus and the fallopian tubes, preventing fertilization (Videla-Rivero et al. 1987). Section of system Levonorgestrel

More information

Multipurpose Intravaginal Ring: Tenofovir / Levonorgestrel

Multipurpose Intravaginal Ring: Tenofovir / Levonorgestrel MTN Annual Meeting Bethesda, MD March 17, 2015 Multipurpose Intravaginal Ring: Tenofovir / Levonorgestrel Christine Mauck, MD, MPH Why develop a multipurpose ring? Providing drug in a ring is likely to

More information

What s New in Adolescent Contraception?

What s New in Adolescent Contraception? What s New in Adolescent Contraception? Abby Furukawa, MD Legacy Medical Group Portland Obstetrics and Gynecology April 29, 2017 Objectives Provide an update on contraception options for the adolescent

More information

Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle?

Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle? Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle? Introduction: The menstrual cycle (changes within the uterus) is an approximately 28-day cycle that

More information

25 mg oestradiol implants--the dosage of first choice for subcutaneous oestrogen replacement therapy?

25 mg oestradiol implants--the dosage of first choice for subcutaneous oestrogen replacement therapy? Research Subcutaneous estrogen replacement therapy. Jones SC. Journal of Reproductive Medicine March, 2004; 49(3):139-142. Department of Obstetrics and Gynecology, Keesler Medical Center, Keesler Air Force

More information

The biology of menstrually related. Ovulation Suppression of Premenstrual Symptoms Using Oral Contraceptives REPORTS. Patricia J.

The biology of menstrually related. Ovulation Suppression of Premenstrual Symptoms Using Oral Contraceptives REPORTS. Patricia J. REPORTS Ovulation Suppression of Premenstrual Symptoms Using Oral Contraceptives Patricia J. Sulak, MD Abstract Managing premenstrual symptoms at the most fundamental level necessitates careful consideration

More information

PCOS and Obesity DUB is better treated by OCPs

PCOS and Obesity DUB is better treated by OCPs PCOS and Obesity DUB is better treated by OCPs Dr. Ritu Joshi Senior consultant Fortis escorts Hospital, Jaipur Chairperson Family welfare com. FOGSI (20092012) Vice President FOGSI 2014 Introduction One

More information

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society

More information

SAMPLE REPORT. Order Number: PATIENT. Age: 40 Sex: F MRN:

SAMPLE REPORT. Order Number: PATIENT. Age: 40 Sex: F MRN: Patient: Age: 40 Sex: F MRN: SAMPLE PATIENT Order Number: Completed: Received: Collected: SAMPLE REPORT Progesterone ng/ml 0.34 0.95 21.00 DHEA-S mcg/dl Testosterone ng/ml 48 35 0.10 0.54 0.80 430 Sex

More information

Abnormal Uterine Bleeding Case Studies

Abnormal Uterine Bleeding Case Studies Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead

More information

Female sex steroids and contraceptives agents

Female sex steroids and contraceptives agents Female sex steroids and contraceptives agents Female Sex Hormones Sex hormones produced by the gonads are necessary for conception, embryonic maturation, and development of primary and secondary sexual

More information

Reproductive FSH. Analyte Information

Reproductive FSH. Analyte Information Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary

More information

What is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this...

What is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this... PCOS What is PCOS? You'll be amazed when you read this... What is PCOS?. Who is at risk? How to get tested? What are the complications. Is there a cure? What are the right ways to eat? What lifestyle changes

More information

Oskari Heikinheimo 1,3, Päivi Lehtovirta 1, Jukka Suni 2 and Jorma Paavonen 1

Oskari Heikinheimo 1,3, Päivi Lehtovirta 1, Jukka Suni 2 and Jorma Paavonen 1 Human Reproduction Vol.21, No.11 pp. 2857 2861, 26 Advance Access publication July 31, 26. doi:1.193/humrep/del264 The levonorgestrel-releasing intrauterine system (LNG-IUS) in HIV-infected women effects

More information

Unintended Pregnancy is Common LEARNING OBJECTIVES. Distribution Of Contraception Use By Women In The Us. Unintended Pregnancy And Contraceptive Use

Unintended Pregnancy is Common LEARNING OBJECTIVES. Distribution Of Contraception Use By Women In The Us. Unintended Pregnancy And Contraceptive Use 3:45 4:30 pm Beyond the Pill: Long Acting Contraceptives and IUDs Presenter Disclosure Information The following relationships exist related to this presentation: Christine L. Curry, MD, PhD: No financial

More information

Application for inclusion of levonorgestrel - releasing IUD for contraception in the WHO Model List of Essential Medicines

Application for inclusion of levonorgestrel - releasing IUD for contraception in the WHO Model List of Essential Medicines Application for inclusion of levonorgestrel - releasing IUD for contraception in the WHO Model List of Essential Medicines 1. Summary statement of the proposal for inclusion LNG-IUS is an effective contraceptive;

More information

Reproductive Health and Pituitary Disease

Reproductive Health and Pituitary Disease Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives

More information

Contraception. Objectives. Unintended Pregnancy. Unintended Pregnancy in the US. What s the Impact? 10/7/2014

Contraception. Objectives. Unintended Pregnancy. Unintended Pregnancy in the US. What s the Impact? 10/7/2014 Contraception Tami Allen, RNC OB, MHA Robin Petersen, RN, MSN Perinatal Clinical Nurse Specialist Objectives Discuss the impact of unintended pregnancy in the United States Discuss the risks and benefits

More information

Fertility Diagnostics

Fertility Diagnostics Fertility Diagnostics Fertility hormones measured on PATHFAST For internal use only Diagnostics PATHFAST Chemiluminescence-immuno-analyzer 1 Content: page 1. Fertility hormones - general aspects 1.1 Reproductive

More information

Therapeutic Cohort Results

Therapeutic Cohort Results Patient: SAMPLE PATIENT DOB: Sex: MRN: Menopause Plus - Salivary Profile Therapeutic Cohort Results Hormone Average Result QUINTILE DISTRIBUTION 1st 2nd 3rd 4th 5th Therapeutic Range* Estradiol (E2) 8.7

More information

Hormonal Control of Human Reproduction

Hormonal Control of Human Reproduction Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with

More information

Hormonal Contraception: Asian View. Hormonal Contraception: Asian View: focused on Chinese View. Prof.Dr.Xiangyan Ruan, MD.PhD

Hormonal Contraception: Asian View. Hormonal Contraception: Asian View: focused on Chinese View. Prof.Dr.Xiangyan Ruan, MD.PhD Asian View Prof.Dr.Xiangyan Ruan, MD.PhD Beijing Obstetrics & Gynecology Hospital, Capital Medical University (China) WHO Collaborative Centre - Director of Dept. of Gynecological Endocrinology & & - Fertility

More information

MODERN TRENDS. Triphasic oral contraceptives: review and comparison of various regimens. Edward E. Wallach, M.D. Associate Editor

MODERN TRENDS. Triphasic oral contraceptives: review and comparison of various regimens. Edward E. Wallach, M.D. Associate Editor FERTILITY AND STERILITY VOL. 77, NO. 1, JANUARY 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. MODERN TRENDS Edward

More information

N. Shirazian, MD. Endocrinologist

N. Shirazian, MD. Endocrinologist N. Shirazian, MD Internist, Endocrinologist Inside the ovary Day 15-28: empty pyfollicle turns into corpus luteum (yellow body) Immature eggs Day 1-13: 13: egg developing inside the growing follicle Day

More information

Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milano, Milan, Italy

Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milano, Milan, Italy FERTILITY AND STERILITY VOL. 80, NO. 2, AUGUST 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Comparison of a levonorgestrel-releasing

More information

Contraception for Obese Women RENEE E. MESTAD, MD, MSCI ACOG DISTRICT II UPSTATE MEETING APRIL 29, 2016

Contraception for Obese Women RENEE E. MESTAD, MD, MSCI ACOG DISTRICT II UPSTATE MEETING APRIL 29, 2016 Contraception for Obese Women RENEE E. MESTAD, MD, MSCI ACOG DISTRICT II UPSTATE MEETING APRIL 29, 2016 Disclosure I am a Nexplanon trainer for Merck. Objectives Understand how obesity may affect pharmacokinetics

More information

CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology

CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology A 49-year-old woman complains of irregular menses over the past 6 months, feelings of inadequacy, vaginal dryness, difficulty sleeping, and episodes

More information

Understanding and Managing Endometriosis. What you should know about treatment options

Understanding and Managing Endometriosis. What you should know about treatment options Understanding and Managing Endometriosis What you should know about treatment options What is endometriosis? Do you feel pain during your monthly period, or do you have lower abdominal pain all month?

More information

COLLECTION OF CRITICALLY APPRAISED TOPICS ON CONTRACEPTION

COLLECTION OF CRITICALLY APPRAISED TOPICS ON CONTRACEPTION COLLECTION OF CRITICALLY APPRAISED TOPICS ON CONTRACEPTION Progestin only pills The Evidence Based Medicine Center, Department of Obstetrics, Gynecology and Reproductology, Ukraine National Medical Academy

More information

WEIGHT CHANGE AND ANDROGEN LEVELS DURING CONTRACEPTIVE TREATMENT OF WOMEN AFFECTED BY POLYCYSTIC OVARY

WEIGHT CHANGE AND ANDROGEN LEVELS DURING CONTRACEPTIVE TREATMENT OF WOMEN AFFECTED BY POLYCYSTIC OVARY ENDOCRINE REGULATIONS, VOL. 40, 119-123, 2006 119 WEIGHT CHANGE AND ANDROGEN LEVELS DURING CONTRACEPTIVE TREATMENT OF WOMEN AFFECTED BY POLYCYSTIC OVARY J. VRBIKOVA, K. DVORAKOVA, M. HILL, L. STARKA Institute

More information

Gonadotrophin treatment in patients with Polycystic Ovary Syndrome

Gonadotrophin treatment in patients with Polycystic Ovary Syndrome Int. J. Adv. Res. Biol. Sci. (218). 5(4): 95-99 International Journal of Advanced Research in Biological Sciences ISSN: 2348-869 www.ijarbs.com DOI: 1.22192/ijarbs Coden: IJARQG(USA) Volume 5, Issue 4-218

More information

Hormonal Treatment of Acne and Hirsutism. Julie C Harper MD

Hormonal Treatment of Acne and Hirsutism. Julie C Harper MD Hormonal Treatment of Acne and Hirsutism Julie C Harper MD none Conflict of Interest Hormonal treatments Combination oral contraceptives Oral antiandrogens Spironolactone Cyproterone acetate Finasteride

More information

LUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi

LUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency

More information

Dr Mary Birdsall. Fertility Associates Auckland

Dr Mary Birdsall. Fertility Associates Auckland Dr Mary Birdsall Fertility Associates Auckland Period Problems Mary Birdsall Medical Director Fertility Associates Auckland Period Problems Basic Physiology No Periods Irregular Periods Heavy Periods

More information

Polycystic Ovarian Syndrome (PCOS) LOGO

Polycystic Ovarian Syndrome (PCOS) LOGO Polycystic Ovarian Syndrome (PCOS) Ma qianhong Ob/Gyn Department LOGO Contents Epidemiology and Definition Pathophysiology, Endocrinological Features Diagnostic Criteria Treatment Prognosis Introduction

More information

5. Summary of Data Reported and Evaluation

5. Summary of Data Reported and Evaluation 168 IARC MONOGRAPHS VOLUME 91 5. Summary of Data Reported and Evaluation 5.1 Exposure data The first oral hormonal contraceptives that were found to inhibit both ovulation and implantation were developed

More information

GONADAL FUNCTION: An Overview

GONADAL FUNCTION: An Overview GONADAL FUNCTION: An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences Clinical Biochemistry BMLS III & BDS IV VJ Temple 1 What are the Steroid hormones?

More information

Reproductive physiology

Reproductive physiology Reproductive physiology Sex hormones: Androgens Estrogens Gestagens Learning objectives 86 (also 90) Sex Genetic sex Gonadal sex Phenotypic sex XY - XX chromosomes testes - ovaries external features Tha

More information

INTERMITTENT BROMOCRIPTINE TREATMENT FOR THE INDUCTION OF OVULATION IN HYPERPROLACTINEMIC PATIENTS*

INTERMITTENT BROMOCRIPTINE TREATMENT FOR THE INDUCTION OF OVULATION IN HYPERPROLACTINEMIC PATIENTS* FERTILITY AND STERIUTY Copyright 979 The American Fertility Society Vol. 3, No.3, March 979 Printed in U.s A. INTERMITTENT BROMOCRIPTINE TREATMENT FOR THE INDUCTION OF OVULATION IN HYPERPROLACTINEMIC PATIENTS*

More information

Natural Hormones Replacement An Evidence and Practice Based Approach

Natural Hormones Replacement An Evidence and Practice Based Approach Natural Hormones Replacement An Evidence and Practice Based Approach Andres Ruiz, PharmD, MSc, FACA President/Partner Stonegate Pharmacy PRESENTED BY THE AMERICAN COLLEGE OF APOTHECARIES 2830 SUMMER OAKS

More information

Dr John Short Obstetrician and Gynaecologist Christchurch Women s Hospital Christchurch

Dr John Short Obstetrician and Gynaecologist Christchurch Women s Hospital Christchurch Dr John Short Obstetrician and Gynaecologist Christchurch Women s Hospital Christchurch 8:15-9:10 WS #195: Contraception and Infertility Update for GPs 9:20-10:15 WS #207: Contraception and Infertility

More information

in vitro fertilization

in vitro fertilization FERTILITY AND STERILITY VOL 69, NO. 6, JUNE 1998 Copyright (#1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Elevated levels of basal

More information

Labrix Clinical Services, Inc.

Labrix Clinical Services, Inc. Labrix Clinical Services, Inc. Advantages of Labrix Clinical Services, Inc. We Cater to the Healthcare Practitioner Labrix sample collection tubes are small; only 1 ml of saliva is required from the patient.

More information

THE RELATION BETWEEN PLASMA TESTOSTERONE LEVELS AND THE LENGTHS OF PHASES OF THE MENSTRUAL CYCLE*

THE RELATION BETWEEN PLASMA TESTOSTERONE LEVELS AND THE LENGTHS OF PHASES OF THE MENSTRUAL CYCLE* FERTILITY AND STERILITY Copyright 1979 The American Fertility Society Vol. 32, No.4, October 1979 Printed in U.s.A. THE RELATION BETWEEN PLASMA TESTOSTERONE LEVELS AND THE LENGTHS OF PHASES OF THE MENSTRUAL

More information

Web Activity: Simulation Structures of the Female Reproductive System

Web Activity: Simulation Structures of the Female Reproductive System differentiate. The epididymis is a coiled tube found along the outer edge of the testis where the sperm mature. 3. Testosterone is a male sex hormone produced in the interstitial cells of the testes. It

More information

Case Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation

Case Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine

More information

Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY

Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:

More information

5. Summary of Data Reported and Evaluation

5. Summary of Data Reported and Evaluation 326 5. Summary of Data Reported and Evaluation 5.1 Exposure data Combined estrogen progestogen menopausal therapy involves the co-administration of an estrogen and a progestogen to peri- or postmenopausal

More information

Progesterone, A Central Role in Hormone Balance and Cycle Control Today s Ignorance of Hormonal Importance:

Progesterone, A Central Role in Hormone Balance and Cycle Control Today s Ignorance of Hormonal Importance: G eorgia H orm ones, P.C. R obert P. G oldm an, M D 3400-A O ld M ilton P kw k y, Suite 360, A lpharetta G A 30005 770-475 475-0077 w w w.g eorgiah orm ones.com 2009-05-18 Progesterone, A Central Role

More information

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty

More information

The International Menopause Society (IMS) defines menopause (natural menopause) as:

The International Menopause Society (IMS) defines menopause (natural menopause) as: The International Menopause Society (IMS) defines menopause (natural menopause) as: the permanent cessation of menstruation resulting from the loss of ovarian follicular activity On average, it occurs

More information

Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes

Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes POLYCYSTIC OVARY SYNDROME Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes Ettore Guastella, M.D., a Rosa Alba Longo, M.D., b and Enrico Carmina, M.D. b a Department

More information

Female Reproduction 1 and 2: The Menstrual Cycle R.J. Witorsch, Ph.D.

Female Reproduction 1 and 2: The Menstrual Cycle R.J. Witorsch, Ph.D. Female Reproduction 1 and 2: The Menstrual Cycle R.J. Witorsch, Ph.D. OBJECTIVES: At the end of this block of lectures, the student should be able to: 1. Describe the functional anatomy of ovary with particular

More information

Update on Medical and Surgical Therapy Sara Jane Pieper, MD Chair, Gynecology Development Team

Update on Medical and Surgical Therapy Sara Jane Pieper, MD Chair, Gynecology Development Team ABNORMAL UTERINE BLEEDING Update on Medical and Surgical Therapy Sara Jane Pieper, MD Chair, Gynecology Development Team Goals Review appropriate medical therapies for abnormal uterine bleeding Review

More information

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective

More information

Infertility: A Generalist s Perspective

Infertility: A Generalist s Perspective Infertility: A Generalist s Perspective Learning Objectives Fertility and Lifestyle: Patient education Describe the basic infertility workup Basic treatment strategies unexplained Heather Huddleston, MD

More information

Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate*

Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate* FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in U.8A. Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene

More information

Family Planning د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد

Family Planning د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد Family Planning د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد Objectives:- To know the different types of contraception To know the failure rate & mechansim of action of each type To explain

More information

Prof.Dr. Nabil Lymon Head of Internal Medicine Department

Prof.Dr. Nabil Lymon Head of Internal Medicine Department By Prof.Dr. Nabil Lymon Head of Internal Medicine Department Definitions: Hirsutism: Is the presence of terminal hair in androgendependent sites where hair does not normally grow in women. This hair growth

More information

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome Polycystic Ovary Syndrome Kathleen Colleran, MD Professor of Medicine University of New Mexico HSC Presented for COMM-TC May 4, 2012 Objectives Understand the pathophysiology of PCOS Understand how to

More information

Ardhanu Kusumanto Oktober Contraception methods for gyne cancer survivors

Ardhanu Kusumanto Oktober Contraception methods for gyne cancer survivors Ardhanu Kusumanto Oktober 2017 Contraception methods for gyne cancer survivors Background cancer treatment Care of gyn cancer survivor Promotion of sexual, cardiovascular, bone, and brain health management

More information

Central Progesterone Involvement in Estrogen- Induced Prolactin and Luteinizing Hormone Secretion Surges in Female Rats

Central Progesterone Involvement in Estrogen- Induced Prolactin and Luteinizing Hormone Secretion Surges in Female Rats Southern Illinois University Carbondale OpenSIUC Honors Theses University Honors Program 5-10-2014 Central Progesterone Involvement in Estrogen- Induced Prolactin and Luteinizing Hormone Secretion Surges

More information

Topic 24: Estrogens and Female Reproductive Drugs

Topic 24: Estrogens and Female Reproductive Drugs Topic 24: Estrogens and Female Reproductive Drugs I. Contraceptives A. Estrogen-Progestin Contraceptives Note all of these drugs contain one estrogen (listed first) and one progestin Drug to know: ethinyl

More information

Polycystic Ovary Syndrome (PCOS):

Polycystic Ovary Syndrome (PCOS): Polycystic Ovary Syndrome (PCOS): Current diagnosis and treatment Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the end of this presentation,

More information

2

2 1 2 3 1. Usinger KM et al. Intrauterine contraception continuation in adolescents and young women: a systematic review. J Pediatr Adolesc Gynecol 2016; 29: 659 67. 2. Kost K et al. Estimates of contraceptive

More information

Overview of Reproductive Endocrinology

Overview of Reproductive Endocrinology Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,

More information

Department of Obstetrics and Gynecology, Changhua Christian Hospital, Institute of Medical Research, Chang Jung University, Changhua 500, Taiwan

Department of Obstetrics and Gynecology, Changhua Christian Hospital, Institute of Medical Research, Chang Jung University, Changhua 500, Taiwan Endocrine Journal 2005, 52 (4), 407 412 Relationship between Sex Hormone-Binding Globulin and Pregnancy Outcome in Women Undergoing Controlled Ovarian Hyperstimulation for Assisted Reproduction KUO-CHERNG

More information

A Tale of Three Hormones: hcg, Progesterone and AMH

A Tale of Three Hormones: hcg, Progesterone and AMH A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,

More information

POTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL. Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist

POTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL. Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist POTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist THE PILL Released to US market in 1960 10-15 x dose of hormones in HRT Over 10-14

More information

Original Policy Date

Original Policy Date MP 5.01.30 Implantable Hormone Pellets Medical Policy Section Prescription Drug Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Local Policy created with literature search/12:2013 Return

More information

Bioidentical Hormone Preparations - History of Development

Bioidentical Hormone Preparations - History of Development Bioidentical Hormone Preparations - History of Development The use of the terminology BIOIDENTICAL HORMONE therapy has aroused much controversy and heated debate over the past 20 years, often with much

More information

Gynecologic Considerations in Women with FA

Gynecologic Considerations in Women with FA Gynecologic Considerations in Women with FA RAHEL GHEBRE, M.D., MPH University of Minnesota Medical School Objectives Recommendation for Gynecologic Care FA girls starting at age 16 should establish a

More information

THE CERVICAL FACTOR IN INFERTILITY: DIAGNOSIS AND TREATMENT

THE CERVICAL FACTOR IN INFERTILITY: DIAGNOSIS AND TREATMENT FERTILITY AND STERILITY Copyright ' 1977 The American Fertility Society Vol. 28, No. 12, December 1977 Printed in U.S.A. THE CERVICAL FACTOR IN INFERTILITY: DIAGNOSIS AND TREATMENT JOSEF Z. SCOT!" M.D.*

More information

New Zealand Datasheet

New Zealand Datasheet New Zealand Datasheet 1 PRODUCT NAME POSTINOR-1 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Levonorgestrel 1.5 mg 3 PHARMACEUTICAL FORM Each round white tablet contains 1.5 mg of levonorgestrel. The tablet

More information

The Science of your Cycle

The Science of your Cycle The Science of your Cycle Day 3: Get to know your cycle (Part I) with Jennifer Aldoretta Cofounder & CEO of Groove Today s goals Learn how your hormones work together to create the changes that happen

More information

Psychosocial Aspects of Family Planning: Hormonal Contraception and Mood

Psychosocial Aspects of Family Planning: Hormonal Contraception and Mood Psychosocial Aspects of Family Planning: Hormonal Contraception and Mood Overview: This case discusses possible psychological effects that may be caused by hormonal contraception (HC). The reader should

More information

Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? *

Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? * Middle East Fertility Society Journal Vol. 11, No. 2, 2006 Copyright Middle East Fertility Society Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? * Amany A.M. Shaltout, M.D. Mohamed

More information

Dysfunctional Uterine Bleeding (DUB) OB/GYN Hospital of Fudan University Weiwei Feng, MD,Ph D Tel:

Dysfunctional Uterine Bleeding (DUB) OB/GYN Hospital of Fudan University Weiwei Feng, MD,Ph D   Tel: Dysfunctional Uterine Bleeding (DUB) OB/GYN Hospital of Fudan University Weiwei Feng, MD,Ph D Email: wfeng7347@aliyun.com Tel: 13918551061 2014-8-20 Contents DUB: definition, mechanism of normal menses,

More information

Ovarian Hormone Replacement. Maria Wolfs MD MHSc FRCPC Assistant Professor University of Toronto Endocrinology St. Michael s Hospital

Ovarian Hormone Replacement. Maria Wolfs MD MHSc FRCPC Assistant Professor University of Toronto Endocrinology St. Michael s Hospital Ovarian Hormone Replacement Maria Wolfs MD MHSc FRCPC Assistant Professor University of Toronto Endocrinology St. Michael s Hospital Disclosures None to declare Outline Hormones and the Menstrual cycle

More information

The contributions of oestrogen and growth factors to increased adrenal androgen secretion in polycystic ovary syndrome

The contributions of oestrogen and growth factors to increased adrenal androgen secretion in polycystic ovary syndrome Human Reproduction vol.14 no.2 pp.307 311, 1999 The contributions of oestrogen and growth factors to increased adrenal androgen secretion in polycystic ovary syndrome E.Carmina 1, F.Gonzalez 2, A.Vidali

More information

PCOS across the Lifespan: An Update on Diagnosis and Management

PCOS across the Lifespan: An Update on Diagnosis and Management PCOS across the Lifespan: An Update on Diagnosis and Management Heather Gibson Huddleston, MD Assistant Professor University of California San Francisco PCOS: Overview Most common endocrine disorder reproductive

More information

Test Results SB Samples Arrived: 01/15/2014 Samples Collected: Saliva: 01/11/14 07:14 Date Closed: 01/18/2014

Test Results SB Samples Arrived: 01/15/2014 Samples Collected: Saliva: 01/11/14 07:14 Date Closed: 01/18/2014 Test Results 8605 SW Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636 info@zrtlab.com www.zrtlab.com 2014 01 15 001 SB Samples Arrived: 01/15/2014 Samples Collected: Saliva: 01/11/14

More information

Reproduction and Development. Female Reproductive System

Reproduction and Development. Female Reproductive System Reproduction and Development Female Reproductive System Outcomes 5. Identify the structures in the human female reproductive system and describe their functions. Ovaries, Fallopian tubes, Uterus, Endometrium,

More information

Disturbance of uterine bleeding patterns, often anecdotally

Disturbance of uterine bleeding patterns, often anecdotally Management of Initial Bleeding or Spotting After Levonorgestrel-Releasing Intrauterine System Placement A Randomized Controlled Trial Terje Sørdal, MD, Pirjo Inki, MD, PhD, John Draeby, MD, Mary O Flynn,

More information

SPRMs in Gynecology. Claude-A. Fortin md Asst.Prof Ob-Gyn McGill University Montreal

SPRMs in Gynecology. Claude-A. Fortin md Asst.Prof Ob-Gyn McGill University Montreal SPRMs in Gynecology Claude-A. Fortin md Asst.Prof Ob-Gyn McGill University Montreal Disclosure Consultant : Johnson & Johnson Speaker : Pfizer, Warner Chilcott, Ethicon (Gynecare ), Actavis Research Grants

More information

MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure.

MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure. Chapter 27 Exam Due NLT Thursday, July 31, 2015 Name MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure. Figure 27.1 Using Figure 27.1, match the following:

More information

One Day Hormone Check

One Day Hormone Check One Day Hormone Check Patient: EMILY TEST DOB: January 18, 1948 Sex: F MRN: 0000000004 Order Number: J5070009 Completed: March 07, 2014 Received: March 07, 2014 Collected: March 07, 2014 Alec Smart, ND

More information

Thrombosis and Women s Health Risk factors, contraceptive pill, HRT and your doctor

Thrombosis and Women s Health Risk factors, contraceptive pill, HRT and your doctor Thrombosis and Women s Health Risk factors, contraceptive pill, HRT and your doctor Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service

More information

Top 5 Fertility Secrets Revealed

Top 5 Fertility Secrets Revealed Top 5 Fertility Secrets Revealed by Melinda Stevens Brought to you by http://www.pregnancy-online.info All rights reserved, 2007. Copyright 2007, Pregnancy-Online.info 2 Hi, thanks for downloading my free

More information

Ovulation after intravenous and intramuscular human chorionic gonadotropin*t

Ovulation after intravenous and intramuscular human chorionic gonadotropin*t FERTILITY AND STERILITY Copyright 1993 The American Fertility Society Printed on acid-free paper in U. S. A. Ovulation after intravenous and intramuscular human chorionic gonadotropin*t Robin A. Fischer,

More information

Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome?

Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? www.ijpm.in www.ijpm.ir Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? Ferdous Mehrabian, Maryam Afghahi Department

More information

Prometrium dose for luteal phase defect

Prometrium dose for luteal phase defect Search Search Prometrium dose for luteal phase defect I know my short luteal phase is caused by low progesterone infertility, should I try vitex, vitamin B6, or just got the progesterone cream route?.

More information

Long Acting Reversible Contraception: First Line Care for Adolescents. David A. Levine, MD, FAAP Melissa Kottke, MD, MPH, FACOG

Long Acting Reversible Contraception: First Line Care for Adolescents. David A. Levine, MD, FAAP Melissa Kottke, MD, MPH, FACOG Long Acting Reversible Contraception: First Line Care for Adolescents David A. Levine, MD, FAAP Melissa Kottke, MD, MPH, FACOG Disclosures Melissa Kottke is a Nexplanon trainer for Merck Objectives Describe

More information

The Human Menstrual Cycle

The Human Menstrual Cycle The Human Menstrual Cycle Name: The female human s menstrual cycle is broken into two phases: the Follicular Phase and the Luteal Phase. These two phases are separated by an event called ovulation. (1)

More information