Prosprective study of the forearrm bone mineral density of long-term users of levonorgestrel - releasing intrauterine syustem

Orientador: Ilza Maria Urbano MonteiroDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: A osteoporose é uma doença sistêmica que afeta principalmente as mulheres. Alguns dos fatores que aceleram a aparição desta doença são a idade e o uso, por longa data, de métodos anticoncepcionais com somente progestágenos. O sistema intrauterino liberador de levonorgestrel (SIU-LNG) é um método difundido para a contracepção e o tratamento de diversas patologias ginecológicas. Na literatura não foram identificados estudos longitudinais prospectivos, com usuárias de longa data deste método, que avaliem seus efeitos sobre a densidade mineral óssea (DMO). Objetivos: Avaliar a DMO em usuárias do SIU-LNG aos sete anos de uso e comparar com elas mesmas aos 10 anos de uso e com um grupo-controle de usuárias de método anticoncepcional não hormonal. Sujeitos e métodos: do total de 37 mulheres que realizaram DMO no antebraço aos sete anos de uso do SIU-LNG, foi avaliada a DMO novamente aos 10 anos de uso. Cada usuária foi pareada com uma usuária de DIU TCu380A, com o mesmo tempo de uso, por idade (± 1 ano), índice de massa corporal (IMC; kg/m2) (± 1), cor da pele e número de gravidezes (± 1). A DMO foi avaliada no antebraço não dominante no rádio distal (midshaft ulna) e no rádio ultradistal usando double X-ray absorptiometry. Os dados foram avaliados pelos testes t de Student pareado, Wilcoxon, Snedecor (ANOVA) e Índice de correlação múltipla. Resultados: A DMO das usuárias do SIU-LNG aos 10 anos de uso foi estatisticamente similar que aos sete anos e similar que os seus controles, usuárias de DIU TCu380A, mesmo quando pareadas por idade (± 1 ano), índice de massa corporal [IMC; kg/m2, (± 1)], cor da pele e número de gestações (± 1). A maior DMO das usuárias do SIU-LNG aos 10 anos foi significativamente associada ao maior IMC (kg/m2) e maior DMO aos sete anos de uso. Conclusão: As DMO dos antebraços distal e ultradistal foram similares entre as usuárias do SIU-LNG aos sete e 10 anos de uso, e também quando comparadas com um grupo de não usuárias deste contraceptivoAbstract: Introduction: Osteoporosis is a systemic disease which mainly affects women. Some of the factors which provoke an acceleration of the initiation of this disease were age and use for a long-term of progestin-only contraceptive methods. The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely introduced method for contraception and for the treatment of several gynecological pathologies. On the literature we were unable to identify prospective studies with long-term users of this method which evaluated their effect upon bone mineral density (BMD). Objectives: To assess prospectively the BMD of users of the LNG-IUS at the 7th year of use and compare with the same women at the 10th year of use and with a control group of users of a non-hormonal contraceptive method. Materials and methods: A total of 37 women who performed a forearm BMD at the 7th year of use and again at the 10th year of use. Each woman was paired with a woman who had been using a copper IUD TCu380A for at least the same length of time, who never use an LNG-IUS matched by age (±1 year), body mass index (BMI; kg/m2) (±1), ethnicity, and number of pregnancies (±1). BMD was evaluated at the distal and the ultra-distal radius of the nondominant forearm using double X-ray absorptiometry. The data was evaluated trough t-Student test for paired samples, Wilcoxon, Snedecor (ANOVA) and multiple logistic regression. Results: The BMD of LNG-IUS users at the 10th year of use was statistically similar than themselves when use at the 7th year as well as similar as controls users of the TCu380A IUD even when paired by age (± 1 year), body mass index (BMI; Kg/m2, (± 1), race and number of pregnancies (± 1). Higher BMD of the LNG-IUS at the 10th year of use was significantly associated to a high BMI (Kg/m2) and higher BMD at the 7th year of use. Conclusions: Forearm BMD at distal and ultra-distal radius was similar among users of the LNG-IUS at the 7th and at the 10th year of use and was also similar when compared users with non-users of this contraceptive methodMestradoTocoginecologiaMeste em Tocoginoclogi

Comparison Of Two Cohorts Of Women Who Expulsed Either A Copper-intrauterine Device Or A Levonorgestrel-releasing Intrauterine System.

To assess if there is a difference in the characteristics of the women who expelled a copper-intrauterine device (TCu-IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS) and the frequency of expulsions over different periods of observation. We retrospectively analyzed 19 697 medical charts of women consulting between January 1980 and December 2013 who requested a TCu-IUD or a LNG-IUS. The medical records of 17 644 Cu-IUD and 2053 LNG-IUS users returning to the clinic for a follow-up visit after insertion of an IUC were reviewed. Of these, 1532 Cu-IUD and 254 LNG-IUS parous users were found to have expelled the IUC for a first time. The mean age at insertion (± standard deviation) was 26.3 ± 6.6 years (range 16-49) for Cu-IUD users and 31.7 ± 7.6 years (range 18-48) for LNG-IUS users (P < 0.001). A total of 263 (13.4%) and 12 (4.3%) of the Cu-IUD and the LNG-IUS users were ≤19 years old, and 49.1% and 54.1% of the expulsions among the Cu-IUD and LNG-IUS users, respectively, were reported in the first six months after placement. A regression model showed that the variables significantly associated with an expulsion of either a Cu-IUD or LNG-IUS were age < 25 years, less than two deliveries and using a Cu-IUD. Our findings showed that the characteristics associated with IUC expulsion were age under 25 years, having had less than two deliveries and being users of Cu-IUD.4

Emerging Female Contraceptives.

Fifty years after the first contraceptive, the market remains restricted regarding composition, cost and routes of administration, and satisfying the needs of millions of women with different requirements according to their stage in life. Women need contraception for almost 30 years of their life. Currently available contraceptives are highly effective with few side effects. This review provides information on emerging female contraceptives including some registered and others at different stages of development. Research efforts aim to reduce costs, improve acceptability and refine 'forgettable' reversible methods. Although developing and testing a new method is laborious and expensive, many new contraceptives are currently under development including different routes of administration. New methods should be affordable, simple to use and suitable for many women. Much work remains to be done and new methods that act on the fusion process between both gametes are desirable without affecting the hormonal milieu.16373-8

[weight Variation In Users Of The Levonorgestrel-releasing Intrauterine System, Of The Copper Iud And Of Medroxyprogesterone Acetate In Brazil].

Assess weight variations in Brazilian users of the 20 microg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) for comparison with a cohort of users of the TCu 380A intrauterine device (IUD) and a cohort of users of the injectable contraceptive, depot-medroxyprogesterone acetate (DMPA) over a period of five years. A total of 163 users of the LNG-IUS, who had the device inserted in 1998, were admitted to the study. At the time of enrollment, each woman was matched by weight (+/- 1 kg) and age (+/- 1 year) to a woman using a TCu 380A IUD and to another woman using DMPA. All women were followed up for a period of five years. Each year weight was measured and the body mass index (BMI, kg/m2) was calculated. Age of the LNG-IUS users was 27.0 +/- 6.7 years (mean +/- SD), while age of the copper IUD users was 28.0 +/- 6.6 years and that of DMPA users was 26.9 +/- 6.5 years. Weight recorded at the onset of the study was 62.9 +/- 0.8 kg, 62.8 +/- 0.8 kg, and 62.5 +/- 0.9 kg (Mean +/- SD) for users of the LNG-IUS, the copper IUD, and DMPA, respectively. The BMI of women was initially 25.0 (+/- 0.3), 26.4 (+/- 0.3), and 25.5 (+/- 0.4), (Mean +/- SD), for users of the LNG-IUS, copper IUD, and DMPA, respectively. Weight increases of 3.1 kg, 4.9 kg and 8.2 kg were observed at the end of the fifth year among users of the LNG-IUS, copper IUD, and DMPA, respectively (p = 0.009). Increase of the BMI was also observed among all groups (final BMI was 26.3 +/- 0.7, 28.5 +/- 0.8 and 28.7 +/- 1.3 for users of the LNG-IUS, copper IUD and DMPA, respectively). Multivariate analysis showed that there was a significant association between weight increase and length of use of the contraceptive method and of the DMPA. The use of a LNG-IUS during five years caused no significant weight increase and the difference in weight was of the same magnitude as that of copper IUD users.5232-

Serum Levonorgestrel Levels And Endometrial Thickness During Extended Use Of The Levonorgestrel-releasing Intrauterine System.

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a contraceptive method approved for five years of use. However, there is some evidence that its life span may be longer. The aim of the study was to evaluate serum levonorgestrel (LNG) and estradiol (E(2)) levels and endometrial thickness every 6 months from 7 to 8 1/2 years after insertion. At the end of the approved 5-year life span, no replacement devices were available; therefore, 86 women were allowed to retain the same device for a further 2 years. At the 7-year follow-up visit, the women who consented were again allowed to retain the same device for a further 18 months and were followed-up at six-monthly intervals. At each visit, vaginal sonography was performed to measure endometrial thickness, and a blood sample was taken to measure LNG and E(2). Eighty-four months after insertion, 67 women aged 34.3+/-0.8 years (mean+/-SEM) (range, 25-49 years) returned for follow-up. Mean+/-SEM LNG levels decreased from an initial 253+/-27 pg/mL (range, 86-760) during the first 2 months following insertion to 137+/-12 (range, 23-393) at 84 months and 119+/-9 pg/mL (range, 110-129) at 102 months of use (+/-SEM). At 84 months of use, mean+/-SEM endometrial thickness was 2.8+/-0.1 mm, increasing to 3.8+/-0.5 mm at 102 months of use. The incidence of amenorrhea decreased from 41.8% at 84 months to 31.5% at 102 months of use. No correlation was found between LNG levels and bleeding patterns; however, a weak correlation was found between high body mass index (kg/m(2)), high weight, and low serum LNG levels. E(2) levels were similar to those of the follicular phase of the menstrual cycle of regularly menstruating women. During extended use of the LNG-IUS, serum LNG levels were nearly half those found in the first 2 months of use (Wilcoxon signed rank test); serum E(2) levels were normal. Despite the very thin endometrium, menstrual bleeding was reinstated in many cases. At the end of its 5-year life span, there is a window for changing the LNG-IUS, and physicians and users should not be concerned about delaying replacement of the device for a short time beyond the approved life span; however, maintaining the same device long after its approved life span cannot be recommended.8084-

Exploratory study of the effect of lifestyle counselling on bone mineral density and body composition in users of the contraceptive depot-medroxyprogesterone acetate

To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Student's t-test followed by multiple linear regression analysis. Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ≥ 1 g/day compared to DMPA users with a lower calcium intake. DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ≥ 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims.To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. Methods An exploratory study in which women aged 18 to 4019244249FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ09/53293-0; 2011/01554-4573747/2008-