1,721,047 research outputs found
Estro-progestin contraceptives and risk of cervical cancer: A debated issue
No full textSteroid contraceptive hormones may promote human papilloma virus (HPV) - DNA integration into the host genome, may bind to specific HPV-DNA sequences within transcriptional regulatory regions, and may modulate cell apoptosis. Most epidemiological studies, reported in this narrative review, have shown that oral contraception is associated with a 1.5-3.3-fold higher relative risk of cervical carcer, but only in users for >5 years and especially in HPV-positive women. The relative risk declines with increasing time since last use and is not different from that of never users after >10 years. Ten-year oral contraceptive use from the age of 20 years is associated with an increase in the cumulative incidence of invasive cervical cancer at the age of 50 years of approximately 1 case per 1,000. Oral contraception has a very small negative impact on the absolute risk of cancer of the uterine cervix
Treatment of hirsutism: comparisons between different antiandrogens with central and peripheral effects.
No full textOBJECTIVE:
To compare the clinical and endocrinologic effects of cyproterone acetate (CPA), an antiandrogen with progestational activity; flutamide, a nonsteroidal antiandrogen, and finasteride, an inhibitor of 5alpha-reductase.
DESIGN:
Randomized, open, controlled clinical study.
SETTING:
Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy.
PATIENT(S):
Forty-five hirsute women were enrolled in the study: 29 were hyperandrogenic and 16 had idiopathic hirsutism. Three women dropped out of the study.
INTERVENTION(S):
Women were randomly treated with finasteride (5 mg/d; n = 14), CPA (25 mg plus ethinyl E2 (EE); n = 13), or flutamide (500 mg/d; n = 15) for 1 year.
MAIN OUTCOME MEASURE(S):
Hirsutism was assessed using the Ferriman-Gallwey method. Levels of total and free T, androstenedione (A), DHEAS, sex hormone-binding globulin, dihydrotestosterone, and 3alpha-androstanediol glucuronide were evaluated at the beginning of the study and every 3 months.
RESULT(S):
Treatment with finasteride, flutamide, and CPA significantly decreased the Ferriman-Gallwey score. The percent decreases in the hirsutism score induced by the different treatments were similar. Treatment with CPA plus EE significantly decreased levels of total and free T, A, dihydrotestosterone, and 3alpha-androstanediol glucuronide. These parameters were unchanged with flutamide therapy. Finasteride significantly increased total T levels but reduced dihydrotestosterone and 3alpha-androstanediol glucuronide concentrations.
CONCLUSION(S):
Finasteride, CPA, and flutamide are equally effective in decreasing hirsutism, despite different mechanisms of action
Effect of long-term naltrexone treatment on endocrine profile, clinical features, and insulin sensitivity in obese women with polycystic ovary syndrome.
No full textAbstract
OBJECTIVE:
Evaluation of clinical and endocrine effects of naltrexone administration in obese women with PCOS.
DESIGN:
Open, controlled, clinical study.
SETTING:
Department of Reproductive Medicine and Child Development, Section of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
PATIENT(S):
Ten PCOS women were studied.
INTERVENTION(S):
Women were treated with naltrexone (50 mg/day) for 6 months.
MAIN OUTCOME MEASURE(S):
Body mass index and the menstrual cyclicity during naltrexone treatment were assessed. Basal levels of LH, FSH, 17beta-estradiol (E(2)), 17-hydroxyprogesterone, total and free T, androstenedione, dehydroepiandrosterone sulfate, cortisol, sex hormone-binding globulin were evaluated before treatment and every 3 months. Progesterone levels were measured in the luteal phase during the sixth month. Gonadotropin response to GnRH administration (10 microg) and a 75-g oral glucose tolerance test were performed before and every 3 months.
RESULT(S):
Body mass index significantly decreased from 29.94 +/- 1.04 to 26.07 +/- 0.81 during treatment. The menstrual cyclicity improved in 80% of PCOS women: the mean cycle length was 40-360 days before treatment and ranged between 25 and 120 days and 28-120 days after 3 and 6 months of treatment. Plasma levels of free T, androstenedione, dehydroepiandrosterone sulfate, and cortisol significantly decreased. Fasting glucose-to-insulin ratio improved in women with insulin resistance.
CONCLUSION(S):
Naltrexone may have a beneficial effect on the clinical and endocrine-metabolic disturbances of obese PCOS women. Whether these effects are the consequences of weight loss or are due to changes in opioidergic tone is debatable
Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels.
No full textAbstract
OBJECTIVE:
To evaluate the metabolic profiles of adolescents with different phenotypes of polycystic ovary syndrome (PCOS).
DESIGN:
Observational study.
SETTING:
University outpatient clinic.
PATIENT(S):
Adolescents with PCOS (n = 120) were divided into four groups: oligomenorrhea and hirsutism (O-H, n = 50), oligomenorrhea, hirsutism, and polycystic ovaries (PCO-O-H, n = 22), oligomenorrhea, hirsutism, and hyperandrogenemia (A-O-H, n = 28), oligomenorrhea, and hirsutism, hyperandrogenemia, and polycystic ovaries (PCO-A-O-H, n = 20). A control group of age-matched adolescents (n = 30) was included.
INTERVENTION(S):
Subjects underwent physical and ultrasound evaluations; fasting blood samples were taken for the measurement of endocrine and metabolic parameters.
MAIN OUTCOME MEASURE(S):
The endocrine and metabolic profiles were evaluated.
RESULT(S):
Adolescents with PCOS showed reduced insulin sensitivity and dyslipidemia. Triglycerides, and total and low-density lipoprotein cholesterol were higher in the phenotypes with hyperandrogenemia. Insulin resistance and body mass index were not significantly different between PCOS phenotypes. Triglyceride positively and high-density lipoportein cholesterol levels negatively correlated with free testosterone and free androgen index.
CONCLUSION(S):
The risk of metabolic alterations may vary in adolescent PCOS patients with different phenotypes. Hyperandrogenemia is a risk factor for dyslipidemia. This information may be of relevance in counseling adolescents with PCOS
Atherogenic lipoprotein phenotype and low-density lipoproteins size and subclasses in women with polycystic ovary syndrome
No full textContext: An altered lipid profile is common in polycystic ovary syndrome
(PCOS) and is usually characterized by increased triglycerides
and low high-density lipoprotein (HDL)-cholesterol levels. In the general
population, these alterations are often associated with the increase
of small low-density lipoproteins (LDLs) in the so-called
“atherogenic lipoprotein phenotype” (ALP) that determines a further
increase of cardiovascular risk. In this study, we evaluated the presence
of ALP in the plasma of women with PCOS.
Setting: Measurements and analysis of LDL size were performed at
the Clinic of Endocrinology, Diabetes, and Clinical Nutrition, University
Hospital, Zurich. PCOS patients were recruited at the Department
of Clinical Medicine, University of Palermo, and the Department
of Obstetrics and Gynecology, University of Pisa.
Patients: Thirty patients with PCOS (hyperandrogenism and
chronic anovulation) and 24 matched controls were studied. Anthropometric
data, blood glucose, serum insulin lipid profile, and LDL size
and subclasses were evaluated.
Results: Compared with controls, patients with PCOS had higher
plasma concentrations of insulin and triglycerides and lower HDLcholesterol
concentrations but no differences in LDL-cholesterol and
total cholesterol. Patients with PCOS had smaller LDL size due to a
reduction in LDL subclass I, with a concomitant increase in LDL
subclasses III and IV. Fourteen PCOS patients had an increase of
smaller LDL particles, and it represented the second most common
lipid alteration after decrease in HDL-cholesterol. However, because
in this PCOS population hypertriglyceridemia was only present in
two patients, complete ALP was relatively uncommon.
Conclusions: Increase of type III or type IV LDL subclasses is a
common finding in PCOS and represents the second most common
lipid alteration after HDL-cholesterol decrease. However, in our
PCOS patients, because of relatively low triglyceride levels, complete
ALP is uncommo
Tailored hormonal approach in women with premature ovarian insufficiency
No full textPremature ovarian insufficiency (POI) is probably one of the most devastating diagnoses for women of reproductive age. The major implications for fertility, climacteric symptoms, and quality of life, the great impact of long-term consequences such as bone loss and cardiovascular health, and the lack of a coherent and shared clinical approach make the choice for the right hormonal therapy challenging. In this review we propose an integrated and patient-based hormonal approach for women with POI, from puberty to late reproductive age
Insulin resistance and hyperandrogenism have no substantive association with birth weight in adolescents with polycystic ovary syndrome
No full textObjective To assess whether birth weight influences the metabolic and hormonal profile of adolescents with polycystic ovary syndrome (PCOS). Design Retrospective study. Setting University outpatient clinic. Patient(s) One hundred seventy consecutive adolescents 12 to 19 years of age with PCOS, 15 of whom were small for gestational age (SGA), and 75 healthy female aged-matched adolescents as controls. Intervention(s) Physical evaluations, fasting blood samples for measuring endocrine and metabolic parameters, and an oral glucose tolerance test. Main Outcomes Measure(s) Physical, endocrine, and metabolic features. Result(s) The birth weights of adolescents with PCOS as well as those with hyperinsulinemic or insulin resistance were similar to those of the control group. The PCOS SGA adolescents had basal insulin (15.93 ± 7.16 μU/mL vs. 10.97 ± 5.79 μU/mL) and homeostasis model assessment of insulin resistance values (3.2 ± 1.54 vs. 2.19 ± 1.28) that were statistically significantly higher than in the control group. The mean levels of total testosterone in the SGA adolescents with PCOS were above the upper limit of the normal range (0.80 ng/mL). Conclusion(s) Low birth weight may influence the appearance of hyperandrogenism and insulin resistance in a portion of adolescents with PCOS, but only 9% of the adolescents with PCOS in this study were SGA. In the majority of adolescents with PCOS, hyperinsulinemia and hyperandrogenism are related to factors other than birth weight alone
Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS)
No full textInsulin resistance (IR) plays a pivotal role in PCOS. Insulin-sensitizer agents such as metformin and inositols have been shown to improve the endocrine and metabolic aspects of PCOS. The purpose of this study is to compare their effects on the clinical and metabolic features of the women with PCOS. Fifty PCOS women with IR and/or hyperinsulinemia were randomized to treatment with metformin (1500 mg/day) or myo-inositol (4 g/day). IR was defined as HOMA-IR >2.5, while hyperinsulinemia was defined as a value of AUC for insulin after a glucose load over the cutoff of our laboratory obtained in normal women. The Matsusa Index has been calculated. The women have been evaluated for insulin secretion, BMI, menstrual cycle length, acne and hirsutism, at baseline and after 6 months of therapy. The results obtained in both groups were similar. The insulin sensitivity improved in both treatment groups. The BMI significantly decreased and the menstrual cycle was normalized in about 50% of the women. No significant changes in acne and hirsutism were observed. The two insulin-sensitizers, metformin and myo-inositol, show to be useful in PCOS women in lowering BMI and ameliorating insulin sensitivity, and improving menstrual cycle without significant differences between the two treatment
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