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Frits R. Rosendaal - One of the best experts on this subject based on the ideXlab platform.
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the risk of deep venous thrombosis associated with injectable depot medroxyprogesterone acetate Contraceptives or a levonorgestrel intrauterine device
Arteriosclerosis Thrombosis and Vascular Biology, 2010Co-Authors: Astrid Van Hylckama Vlieg, Frans M Helmerhorst, Frits R. RosendaalAbstract:Objective— To assess the risk of venous thrombosis associated with nonoral Contraceptives (ie, injectable depot–medroxyprogesterone acetate Contraceptives, hormone [levonorgestrel]–releasing intrauterine devices, a contraceptive patch, or a contraceptive implant). Methods and Results— Analyses were performed in the Multiple Environmental and Genetic Assessment study, a large case-control study on risk factors for venous thrombosis. For the current analyses, we selected premenopausal women, aged 18 to 50 years, who were not pregnant nor within 4 weeks postpartum and were not using oral Contraceptives; 446 patients and 1146 controls were included. Injectable depot–medroxyprogesterone acetate Contraceptives were associated with a 3.6-fold (95% CI, 1.8- to 7.1-fold) increased risk of venous thrombosis compared with nonusers of hormonal Contraceptives. The use of a levonorgestrel intrauterine device was not associated with an increased risk (odds ratio, 0.3; 95% CI, 0.1 to 1.1). Unfortunately, the few women using a contraceptive patch or an implant prevented a reliable estimate of the risk of thrombosis. Conclusion— The risk of venous thrombosis was increased for injectable depot–medroxyprogesterone acetate contraceptive users, while we were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use. Therefore, the latter seems to be the safest option regarding the risk of venous thrombosis.
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The Risk of Deep Venous Thrombosis Associated With Injectable Depot–Medroxyprogesterone Acetate Contraceptives or a Levonorgestrel Intrauterine Device
Arteriosclerosis Thrombosis and Vascular Biology, 2010Co-Authors: Astrid Van Hylckama Vlieg, Frans M Helmerhorst, Frits R. RosendaalAbstract:Objective— To assess the risk of venous thrombosis associated with nonoral Contraceptives (ie, injectable depot–medroxyprogesterone acetate Contraceptives, hormone [levonorgestrel]–releasing intrauterine devices, a contraceptive patch, or a contraceptive implant). Methods and Results— Analyses were performed in the Multiple Environmental and Genetic Assessment study, a large case-control study on risk factors for venous thrombosis. For the current analyses, we selected premenopausal women, aged 18 to 50 years, who were not pregnant nor within 4 weeks postpartum and were not using oral Contraceptives; 446 patients and 1146 controls were included. Injectable depot–medroxyprogesterone acetate Contraceptives were associated with a 3.6-fold (95% CI, 1.8- to 7.1-fold) increased risk of venous thrombosis compared with nonusers of hormonal Contraceptives. The use of a levonorgestrel intrauterine device was not associated with an increased risk (odds ratio, 0.3; 95% CI, 0.1 to 1.1). Unfortunately, the few women using a contraceptive patch or an implant prevented a reliable estimate of the risk of thrombosis. Conclusion— The risk of venous thrombosis was increased for injectable depot–medroxyprogesterone acetate contraceptive users, while we were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use. Therefore, the latter seems to be the safest option regarding the risk of venous thrombosis.
Hershel Jick - One of the best experts on this subject based on the ideXlab platform.
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further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral Contraceptives containing norgestimate and 35 μg of ethinyl estradiol
Contraception, 2007Co-Authors: Susan S Jick, James A Kaye, Hershel JickAbstract:Abstract Context In 2006, we published a study that indicated that the new transdermal contraceptive patch containing ethinyl estradiol (EE) and the progestin norelgestromin did not increase the risk for venous thromboembolism (VTE) compared to oral contraceptive containing norgestimate and 35 μg of EE. Objective This report updates information on the risk of nonfatal VTE in women using the contraceptive patch in comparison to women using oral Contraceptives containing norgestimate (either monophasic or triphasic) and 35 μg of EE (norgestimate-35) using an additional 17months of data. Design, Setting and Participants Nested case-control design based on information from PharMetrics, a US-based company that collects and organizes information on claims paid by managed care plans. The study was nested among all women, aged 15 to 44 years, who started either the contraceptive patch or norgestimate-35 after April 1, 2002. Cases were women with current use of one of these two study drugs and a documented diagnosis of VTE in the absence of identifiable clinical risk factors (idiopathic VTE) who were not in the earlier study. Up to four controls were matched to each case by age and calendar time. Main Outcome Measures Odds ratios (ORs) comparing the risk of nonfatal VTE in new users of the two Contraceptives. Results We identified 56 new cases of newly diagnosed, idiopathic VTE in the updated study population. The OR comparing the contraceptive patch to norgestimate-35 was 1.1 (95% CI 0.6–2.1). Conclusions After evaluating an additional 17 months of data, the results indicate that the risk of nonfatal VTE for the contraceptive patch is closely similar to the risk for oral Contraceptives containing 35 μg of EE and norgestimate.
Edith Weisberg - One of the best experts on this subject based on the ideXlab platform.
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Interactions Between Oral Contraceptives and Antifungals/Antibacterials
Clinical Pharmacokinetics, 1999Co-Authors: Edith WeisbergAbstract:The effectiveness of oral Contraceptives may be impaired by concomitant treatment with antimicrobials. This may occur because of reductions in plasma concentrations of ethinylestradiol by the induction of hepatic metabolism, as for rifampicin (rifampin) and possibly griseofulvin, or in a small percentage of women because of interference with enterohepatic recirculation. There are no scientific data to support the anecdotal evidence that the concomitant use of combined oral Contraceptives and antimicrobials reduces contraceptive efficacy in the majority of women. It has been postulated that there is a subset of women in whom the enterohepatic recirculation of ethinylestradiol plays an important role. In these women the action of an antimicrobial may reduce the efficacy of oral Contraceptives by interfering with this mechanism. Studies that have quantitatively examined these effects may have failed to include women from this subset because of the small numbers involved in the studies. On the other hand, there are no good prospective studies comparing contraceptive failure rates between compliant women who use combined oral Contraceptives with and without antimicrobials. All women using combined oral Contraceptives should be informed of the very low level of risk of interactions with antimicrobials (probably about 1%) and that it is not possible to identify who may be at risk. Women concerned about this low level of risk should be given information about the use of barrier methods or avoidance of intercourse during the first 7 days of concomitant antimicrobial therapy and for 7 subsequent days. Women who have had previous contraceptive failures or developed breakthrough bleeding during concomitant antimicrobial use should be strongly advised to follow these precautions, as they may be part of the subset of women at higher risk of contraceptive failure.
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Interactions between oral Contraceptives and antifungals/antibacterials. Is contraceptive failure the result?
Clinical pharmacokinetics, 1999Co-Authors: Edith WeisbergAbstract:The effectiveness of oral Contraceptives may be impaired by concomitant treatment with antimicrobials. This may occur because of reductions in plasma concentrations of ethinylestradiol by the induction of hepatic metabolism, as for rifampicin (rifampin) and possibly griseofulvin, or in a small percentage of women because of interference with enterohepatic recirculation. There are no scientific data to support the anecdotal evidence that the concomitant use of combined oral Contraceptives and antimicrobials reduces contraceptive efficacy in the majority of women. It has been postulated that there is a subset of women in whom the enterohepatic recirculation of ethinylestradiol plays an important role. In these women the action of an antimicrobial may reduce the efficacy of oral Contraceptives by interfering with this mechanism. Studies that have quantitatively examined these effects may have failed to include women from this subset because of the small numbers involved in the studies. On the other hand, there are no good prospective studies comparing contraceptive failure rates between compliant women who use combined oral Contraceptives with and without antimicrobials. All women using combined oral Contraceptives should be informed of the very low level of risk of interactions with antimicrobials (probably about 1%) and that it is not possible to identify who may be at risk. Women concerned about this low level of risk should be given information about the use of barrier methods or avoidance of intercourse during the first 7 days of concomitant antimicrobial therapy and for 7 subsequent days. Women who have had previous contraceptive failures or developed breakthrough bleeding during concomitant antimicrobial use should be strongly advised to follow these precautions, as they may be part of the subset of women at higher risk of contraceptive failure.
Amanda Black - One of the best experts on this subject based on the ideXlab platform.
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The Combined Contraceptive Vaginal Ring: an Update
Current Obstetrics and Gynecology Reports, 2016Co-Authors: Marie-soleil Wagner, Amanda BlackAbstract:The combined contraceptive vaginal ring releases 120 μg of etonogestrel and 15 μg of ethinylestradiol per day for at least a 3-week period. It is as effective as combined oral contraceptive pills with similar side effects but better cycle control. The ring is not associated with weight gain and may have many non-contraceptive benefits including a positive effect on sexual function, dysmenorrhea, premenstrual syndrome, and heavy menstrual bleeding. Contraindications are the same as for combined oral Contraceptives, and serious complications are rare. The risk of venous thromboembolism with the ring is comparable with that of combined oral Contraceptives. The rate of acceptability of the ring is high, and most women, including adolescents, can use the ring.
Andrew T Goldstein - One of the best experts on this subject based on the ideXlab platform.
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the effects of hormonal Contraceptives on female sexuality a review
The Journal of Sexual Medicine, 2012Co-Authors: Lara J Burrows, Maureen Basha, Andrew T GoldsteinAbstract:Introduction. Hormonal Contraceptives can influence female sexual function. Aim. The goal of this article was to provide a comprehensive review of the effects that various hormonal contra- ceptives may have on female sexual function. Methods. A Medline search was conducted using several terms related to and including the terms contraception, oral contraceptive, female sexual function, dyspareunia, libido, and sexual desire. Results. A thorough review of the effects of hormonal Contraceptives on female sexual function. Conclusions. The sexual side effects of hormonal Contraceptives are not well studied, particularly with regard to impact on libido. There appears to be mixed effects on libido, with a small percentage of women experiencing an increase or a decrease, and the majority being unaffected. Healthcare providers must be aware that hormonal contraceptive can have negative effects on female sexuality so they can counsel and care for their patients appropri- ately. Burrows LJ, Basha M, and Goldstein AT. The effects of hormonal Contraceptives on female sexuality: A review. J Sex Med 2012;9:2213-2223.