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Widiasari Esti - One of the best experts on this subject based on the ideXlab platform.
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HUBUNGAN ANTARA PENGGUNAAN INJEKSI DEPOT-Medroxyprogesterone Acetate (DMPA) DENGAN KADAR ESTRADIOL PADA PENDERITA KANKER PAYUDARA
2017Co-Authors: Widiasari EstiAbstract:HUBUNGAN PENGGUNAAN INJEKSI DEPOT-Medroxyprogesterone Acetate (DMPA) DENGAN KADAR ESTRADIOL PADA PENDERITA KANKER PAYUDARA Esti Widiasari*, Widyanti Soewoto** *Bagian Bedah Fakultas Kedokteran Universitas Sebelas Maret/RSUD Dr. Moewardi Surakarta. **Subbagian Bedah Onkologi Fakultas Kedokteran Universitas Sebelas Maret/RSUD Dr. Moewardi Surakarta. Abstrak Latar Belakang :Depot-Medroxyprogesterone Acetate (DMPA) yaitu kontrasepsi parenteral yang mempunyai efek progesterone yang kuat dan efektif. Penggunaan selama 12 bulan atau lebih dapat mempengaruhi kadar estradiol yang dapat melipat gandakan risiko terkena kanker payudara. Tujuan :Menganalisis adanya hubungan penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) terhadap kadar estradiol pada penderita kanker payudara Metode :Rancangan penelitian ini adalah penelitian analitik observasional dengan pendekatan case control. Sampel dalam penelitian ini adalah 37 orang yang terdiri dari 18 orang dengan riwayat menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi selama 12 bulan, yang dimasukkan ke kelompok I. Dan 19 orang yang tidak pernah menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi, yang dimasukkan ke kelompok II. Teknik sampling yang digunakan pada penelitian ini adalah Consecutive Sampling. Subyek penelitian dibagi 2, kelompok I pasien Kanker Payudara dengan riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi lebih dari 12 bulan, dan kelompok II pasien Kanker Payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA). Tiap kelompok diukur kadar estradiol dari sampel darah dan pemeriksaan dilakukan di laboratorium, dengan pemeriksaan ELISA estradiol. Data yang diperoleh diuji dengan uji mann whitney karena data tidak berdistribusi normal, uji beda dengan menggunakan SPSS 19.0. Hasil :Sebaran menurut umur pada pasien kanker payudara dengan riwayat menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) selama 12 bulan sebagai kontrasepsi , sebaran umur yang paling tinggi pada rentang umur 46-50 tahun (38,9%) dan sebaran umur paling rendah pada rentang umur 56-60 tahun (0%). Pada pasien kanker payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi didapatkan hasil merata pada rentang umur 36-40 tahun (15,78%), rentang umur 41-45 tahun (15,78%), dan rentang umur 66-70 tahun (15,78%). Berdasarkan hasil pengukuran menggunakan Estradiol ELISA kit DRG® diketahui bahwa tidak ada peningkatan kadar estradiol baik pada Pasien Kanker Payudara dengan riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi selama 12 bulan, (kelompok I) dan Pasien Kanker Payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi, (kelompok II). Hasil uji mann whitney pada penelitian ini menunjukkan p = 0,126 (p >0,05). Dengan demikian tidak adanya hubungan antara penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) dengan peningkatan kadar estradiol selama 12 bulan, yang dapat meningkatkan resiko terjadinya Kanker Payudara. Simpulan : Berdasarkan hasil penelitian yang dilakukan terhadap 37 Pasien kanker payudara sejak bulan maret 2016 sampai dengan mei 2016 di sub bagian bedah onkologi RS Dr. Moewardi Surakarta. Maka dapat disimpulkan bahwa penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) tidak berhubungan dengan peningkatan kadar estradiol. Kata kunci :Depot-Medroxyprogesterone Acetate (DMPA), Estradiol, Kontrasepsi, Kanker Payudara
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hubungan antara penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) dengan kadar estradiol pada penderita kanker payudara
2016Co-Authors: Widiasari EstiAbstract:Latar Belakang :Depot-Medroxyprogesterone Acetate (DMPA) yaitu kontrasepsi parenteral yang mempunyai efek progesterone yang kuat dan efektif. Penggunaan selama 12 bulan atau lebih dapat mempengaruhi kadar estradiol yang dapat melipat gandakan risiko terkena kanker payudara. Tujuan :Menganalisis adanya hubungan penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) terhadap kadar estradiol pada penderita kanker payudara Metode :Rancangan penelitian ini adalah penelitian analitik observasional dengan pendekatan case control. Sampel dalam penelitian ini adalah 37 orang yang terdiri dari 18 orang dengan riwayat menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi selama 12 bulan, yang dimasukkan ke kelompok I. Dan 19 orang yang tidak pernah menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi, yang dimasukkan ke kelompok II. Teknik sampling yang digunakan pada penelitian ini adalah Consecutive Sampling. Subyek penelitian dibagi 2, kelompok I pasien Kanker Payudara dengan riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi lebih dari 12 bulan, dan kelompok II pasien Kanker Payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA). Tiap kelompok diukur kadar estradiol dari sampel darah dan pemeriksaan dilakukan di laboratorium, dengan pemeriksaan ELISA estradiol. Data yang diperoleh diuji dengan uji mann whitney karena data tidak berdistribusi normal, uji beda dengan menggunakan SPSS 19.0. Hasil :Sebaran menurut umur pada pasien kanker payudara dengan riwayat menggunakan injeksi Depot-Medroxyprogesterone Acetate (DMPA) selama 12 bulan sebagai kontrasepsi , sebaran umur yang paling tinggi pada rentang umur 46-50 tahun (38,9%) dan sebaran umur paling rendah pada rentang umur 56-60 tahun (0%). Pada pasien kanker payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi didapatkan hasil merata pada rentang umur 36-40 tahun (15,78%), rentang umur 41-45 tahun (15,78%), dan rentang umur 66-70 tahun (15,78%). Berdasarkan hasil pengukuran menggunakan Estradiol ELISA kit DRG® diketahui bahwa tidak ada peningkatan kadar estradiol baik pada Pasien Kanker Payudara dengan riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi selama 12 bulan, (kelompok I) dan Pasien Kanker Payudara tanpa riwayat injeksi Depot-Medroxyprogesterone Acetate (DMPA) sebagai kontrasepsi, (kelompok II). Hasil uji mann whitney pada penelitian ini menunjukkan p = 0,126 (p >0,05). Dengan demikian tidak adanya hubungan antara penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) dengan peningkatan kadar estradiol selama 12 bulan, yang dapat meningkatkan resiko terjadinya Kanker Payudara. Simpulan : Berdasarkan hasil penelitian yang dilakukan terhadap 37 Pasien kanker payudara sejak bulan maret 2016 sampai dengan mei 2016 di sub bagian bedah onkologi RS Dr. Moewardi Surakarta. Maka dapat disimpulkan bahwa penggunaan injeksi Depot-Medroxyprogesterone Acetate (DMPA) tidak berhubungan dengan peningkatan kadar estradiol. Kata kunci :Depot-Medroxyprogesterone Acetate (DMPA), Estradiol, Kontrasepsi, Kanker Payudara
Andrew M. Kaunitz - One of the best experts on this subject based on the ideXlab platform.
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bone density recovery after depot Medroxyprogesterone Acetate injectable contraception use
Contraception, 2008Co-Authors: Andrew M. Kaunitz, Raquel D Arias, Michael McclungAbstract:While depot Medroxyprogesterone Acetate (DMPA) is a highly effective contraceptive used by millions of women, its use is associated with bone mineral density (BMD) loss, raising concerns about long-term risk of osteoporosis and/or fractures.
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long acting injectable contraception with depot Medroxyprogesterone Acetate
American Journal of Obstetrics and Gynecology, 1994Co-Authors: Andrew M. KaunitzAbstract:Depot Medroxyprogesterone Acetate (DIVIPA) is the only injectable contraceptive available in the United States. After more than 20 years of regulatory review, the Food and Drug Administration approved DIVIPA for contraceptive use in 1992 after the publication of reassuring data,about its possible association with breast cancer. It has been used by 30 million women in more than 90 countries. The recommended dosage, 150 mg intramuscularly every 3 months, has a contraceptive efficacy exceeding 99%. After a 150 mg dose, ovulation is inhibited for at least 14 weeks. Almost all users experience menstrual changes, typically episodes of unpredictable irregular spotting and bleeding, particularly during the first year of use. With continued use, spotting and bleeding decrease, and amenorrhea becomes common. Although ovulation suppression may rarely persist for as long as 18 months after the last injection, DIVIPA does not permanently affect fertility. Long-term DIVIPA use reduces menstrual blood loss, has been associated with a decreased incidence of candidal vulvovaginitis and pelvic inflammatory disease, and dramatically lowers the risk of endometrial cancer. Prolonged DIVIPA use may be associated with reversible reduction in bone density, probably related to suppression of endogenous production of estrogen. The most recently published data suggest that long-term use of DIVIPA induces moderate changes in lipid metabolism that are unfavorable in terms of risk of atherosclerosis. DIVIPA should be considered a highly effective, safe, convenient, and reversible contraceptive option for appropriately selected patients.
Carolyn Westhoff - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial of self versus clinical administration of subcutaneous depot Medroxyprogesterone Acetate
Contraception, 2014Co-Authors: Anitra Beasley, Katharine Oconnell White, Serge Cremers, Carolyn WesthoffAbstract:Abstract Objectives To evaluate feasibility, acceptability, continuation, and trough serum levels following self-administration of subcutaneous (sc) depot Medroxyprogesterone Acetate (DMPA). Study design Women presenting to a family planning clinic to initiate, restart or continue DMPA were offered study entry. Participants were randomized in a 2:1 ratio to self- or clinician administered sc DMPA 104 mg. Those randomized to self-administration were taught to self-inject and were supervised in performing the initial injection; they received printed instructions and a supply of contraceptive injections for home use. Participants randomized to clinician administration received usual care. Continued DMPA use was assessed by self-report and trough Medroxyprogesterone Acetate levels at 6 and 12 months. Results Two hundred fifty women were invited to participate, and 137 (55%) enrolled. Of these, 91 were allocated to self-administration, and 90/91 were able to correctly self-administer sc DMPA. Eighty-seven percent completed follow-up. DMPA use at 1 year was 71% for the self-administration group and 63% for the clinic group (p=0.47). Uninterrupted DMPA use was 47% and 48% for the self and clinic administration groups at 1 year (p=0.70), respectively. Serum analyses confirmed similar mean DMPA levels in both groups and therapeutic trough levels in all participants. Conclusions Sixty-three percent of women approached were interested in trying self-administration of DMPA, even in the context of a randomized trial, and nearly all eligible for enrollment were successful at doing so. Self-administration and clinic administration resulted in similar continuation rates and similar DMPA serum levels. Self-administration of sc DMPA is feasible and may be an attractive alternative for many women. Implications Self-administration of sc DMPA is a feasible and attractive option for many women. Benefits include increased control over contraceptive measures and less time spent on contracepting behaviors. Globally, self-administration has the potential to revolutionize contraceptive uptake by increasing the number of women with access to DMPA.
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changes in weight with depot Medroxyprogesterone Acetate subcutaneous injection 104 mg 0 65 ml
Contraception, 2007Co-Authors: Carolyn Westhoff, John K Jain, Ian Milsom, Amrit RayAbstract:Abstract Introduction The study was conducted to assess the impact of depot Medroxyprogesterone Acetate subcutaneous injection 104 mg/0.65 mL (DMPA-SC 104) on body weight. Methods Changes in weight from pretreatment were analyzed using data from two 1-year, noncomparative trials of DMPA-SC 104 (North/South American, N =722; European/Asian, N =1065) and a 3-year, randomized study (SC/IM) comparing DMPA-SC 104 ( N =266) with the DMPA intramuscular injection 150 mg/mL (DMPA-IM 150). For each study, additional analyses were conducted for changes in body weight by age ( 35 years) and body mass index (BMI) (���25, >25 to ���30 and >30 kg/m 2 ) subgroups. Results In both 1-year trials, the mean (��SD) weight gain at month 12 was Conclusion DMPA-SC 104 was associated with modest weight gain in most women.
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depot Medroxyprogesterone Acetate injection depo provera a highly effective contraceptive option with proven long term safety
Contraception, 2003Co-Authors: Carolyn WesthoffAbstract:Depot-Medroxyprogesterone Acetate (Depo-Provera®) is a highly effective, nondaily hormonal contraceptive option that has been available in the United States for a decade, and worldwide for 40 years. Benefits and risks of hormonal therapy are often under scrutiny; however, long-term clinical experience has established the safety of this long-acting contraceptive. This article reviews the contraceptive efficacy, potential noncontraceptive health benefits and long-term safety of with regard to risk of cardiovascular events, breast and gynecologic malignancy and osteopenia. Comparisons with other hormonal contraceptives are made as clinically appropriate. Common patient management issues, including effects on menstrual cycle, body weight and mood, are also addressed. Finally, this review provides recommendations for appropriate patient selection.
Frans A Helmond - One of the best experts on this subject based on the ideXlab platform.
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effects of tibolone and continuous combined conjugated equine estrogen Medroxyprogesterone Acetate on the endometrium and vaginal bleeding results of the opal study
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Robert Langer, Britt Marie Landgren, Janice Rymer, Frans A HelmondAbstract:Objectives The primary objective of the O steoporosis P revention and A rterial effects of tibo L one study was to compare the effect of tibolone and placebo on the progression of the common carotid artery intima-medial thickness; the common carotid artery intima-medial thickness and bone data will be presented elsewhere. A secondary objective was to assess the effects of tibolone (2.5 mg), continuous combined conjugated equine estrogen/Medroxyprogesterone Acetate [0.625/2.5 mg], and placebo on the endometrium and vaginal bleeding; these results are the subject of this report. Study design This 3-year, three-arm, international, randomized, double-blind, parallel group, placebo-controlled clinical trial enrolled 866 postmenopausal women (aged 45-79 years). The endometrium was assessed by annual transvaginal ultrasound scans and end-of-study biopsies (United States/United Kingdom centers only). Vaginal bleeding was recorded in daily diaries. Results Endometrial thickness measured by transvaginal ultrasound scan increased slightly during the first year with tibolone and conjugated equine estrogen/Medroxyprogesterone Acetate, without any further progression. After 3 years, there were no significant differences between the tibolone, conjugated equine estrogen/Medroxyprogesterone Acetate, and placebo groups in the incidence of proliferation (1.4%, 4.8%, and 0%, respectively), endometrial hyperplasia (0% in all groups), or cancer (1, 0, and 1 case, respectively). During the first 3 months, bleeding/spotting rates were greater with conjugated equine estrogen/Medroxyprogesterone Acetate (48%) than with tibolone (18%; P P P = .023 vs tibolone; P P P P P = .001). Conclusion Compared with conjugated equine estrogen/Medroxyprogesterone Acetate, tibolone has a better tolerability profile with respect to vaginal bleeding but with a similar endometrial safety. These results reinforce the endometrial safety profile of tibolone.
Andrea E. Bonny - One of the best experts on this subject based on the ideXlab platform.
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bone mineral density and weight changes in adolescents randomized to 3 doses of depot Medroxyprogesterone Acetate
Journal of Pediatric and Adolescent Gynecology, 2017Co-Authors: Hannah L.h. Lange, Andrea E. Bonny, Brittny E Manos, David M Gothard, Lynette K RogersAbstract:Abstract Study Objective To assess the association between Medroxyprogesterone Acetate exposure and bone mineral density (BMD) loss and weight change in adolescents. Design Forty-eight-week prospective, randomized trial conducted May 2012-April 2014. Setting Recruitment occurred in the general community and outpatient clinics in central Ohio. Participants Self-referred sample of 34 female adolescents aged 12-21 years initiating depot Medroxyprogesterone Acetate (DMPA). Interventions Randomization to 1 of 3 DMPA doses (150, 104, or 75 mg) given intramuscularly every 12 weeks for 48 weeks. Main Outcome Measures Absolute and percent change in BMD from 0-48 weeks at the L1-L4 lumbar spine, total hip, and femoral neck; absolute and percent change in weight at 48 weeks. Results DMPA dose was associated with Medroxyprogesterone Acetate exposure as evidenced by a direct relationship ( P P P Conclusions Our data provide evidence of a dose-response relationship between DMPA and BMD loss. Intramuscular DMPA doses less than 150 mg can decrease risk of BMD loss in adolescents. The risk/benefit ratio of lower-dose DMPA should be further investigated in larger and more diverse adolescent populations.
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serum adipocytokines and adipose weight gain a pilot study in adolescent females initiating depot Medroxyprogesterone Acetate
Contraception, 2015Co-Authors: Hannah L.h. Lange, Andrea E. Bonny, Erinn M Hade, Bram R Kaufman, Michael D Reed, Sam MesianoAbstract:Abstract Objective To evaluate whether serum adipocytokine concentrations, controlling for baseline adiposity, are predictive of adipose weight gain in adolescents initiating depot Medroxyprogesterone Acetate (DMPA). Methods Percent body fat was measured at baseline and 6 months. Baseline serum adipocytokine concentrations were quantified. Results Mean percent body fat was 31.6% (± 7.6) at baseline and 33.5% (± 7.6) at 6 months. In multivariable linear regression modeling (adjusted for baseline percent body fat), Hispanic ethnicity and baseline serum adiponectin concentration were inversely associated (p≤.05) with absolute change in percent body fat at 6 months. Conclusions Serum adiponectin concentration may be useful for assessing risk of DMPA-associated adipose gains.
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a pilot study of depot Medroxyprogesterone Acetate pharmacokinetics and weight gain in adolescent females
Contraception, 2014Co-Authors: Hannah L.h. Lange, Andrea E. Bonny, David M Gothard, Lynette K Rogers, Michael D ReedAbstract:Objective To explore the relationship between Medroxyprogesterone Acetate (MPA) pharmacokinetic (PK) parameter estimates and weight gain.