Family Planning

The contraception (the term is the fusion between “contra”, against, and conception): includes all methods that prevent conception. According to the physiology of human reproduction, the contraceptive methods can prevent the fecundation by hindering the female and male gametes meeting. In these mechanisms we include: The abstinence by sexual intercourse around the ovulatory phase of the cycle; The use of barriers that block contact between male gametes and female genitalia; The use of methods impeding the ascent of spermatozoa through the female genital tracts (intrauterine devices). The prevention of the oocyte from being available (hormonal contraceptives or oral contraceptives, OC). In this category there is the availability of short acting reversible contraception (SARC) (pill, vaginal ring, patch), and the long acting reversible contraception (LARC) (progestin implants). The ideal contraceptive method has to respond to four fundamental principles: efficacy, safety, reversibility, tolerability. The authors will discuss all the above contraceptive methods with the evaluation of indications and contraindications to each method

Chlamydia infection

Chlamydial infection of genital tract is the most common sexually transmitted diseases and can have important complications such as pelvic inflammatory disease and ectopic pregnancy. Several diagnostic methods are now available. The treatments of choice are represented by doxycycline and azithromycin

The stimulation of the vaginal immune system with short-term administration of a vaginal gel containing fraction of Propionibacterium acnes, hyaluronic acid and polycarbophil is efficacious in vaginal infections dependent on disorders in the vaginal ecosystem

The vaginal immune system (VIS) is the first defense against antigens recognized as foreign. Substances capable of locally activating the VIS could be a valid strategy to treat vulvo-vaginal infections (VVI), caused by changes in the vaginal ecosystem, such as bacterial vaginosis (BV), vulvo-vaginal candidiasis (CA), and mixed vaginitis (MV). Bacterial lysates, obtained by crushing bacterial cultures, exert immuno-modulatory activities. The parietal fraction from Propionibacterium acnes is a patent of Depofarma (MoglianoVeneto, Italy). The preparation that associates such fraction to hyaluronic acid and polycarbophil is a registered trademark, commercially available in Italy as vaginal gel, Immunovag®. The study aimed to evaluate whether a 5-day-treatment with Immunovag® improves the symptoms and signs of VVI, in 60 women with Gardnerella vaginalis (GV), 154 with CA, 95 with MV, diagnosed with vulvar vaginal swab (VVS), and in 283 with BV, diagnosed with the Amsel criteria. At the end of the treatment (visit 2), the symptoms and signs of VVI disappeared in a significant number of subjects (χ2p <.02 vs pre-treatment) in all VVI groups, and their intensity was significantly (p <.0002) reduced in the subjects in which they were still present. Immunovag® represents a valid treatment of VVI induced by changes in the vaginal ecosystem

Vilaprisan for treating uterine fibroids

The medical strategy to antagonize myoma size and related-symptoms is to reduce estrogen and progesterone activity on myomas. This can be obtained with the GnRH agonist (GnRHa) or with compounds that antagonize progesterone stimulatory activity on myomas. Selective progesterone receptor modulators (SPRMs) bind progesterone receptor (PR), leading to both agonist and antagonist effects. The result of SPRMs's action is tissue-specific and it depends on the particular affinity and strength of each SPRM. Area covered: Ulipristal acetate (UPA) is the first SPRM registered for myoma treatment. UPA reduces heavy uterine bleeding within 7 days from the onset of treatment, whereas a longer time is required with GnRHa treatment. Vilaprisan is a novel powerful SPRM. Phase I and II studies give encouraging results on the efficacy of vilaprisan at different doses. Like other SPRMs, vilaprisan induces benign changes of endometrium (PR modulator-associated endometrial changes, PAECs). These disappear as treatment is discontinued. Unlike GnRHa treatment, neither UPA nor vilaprisan induce hypoestrogenism and associated symptoms. Phase III studies are ongoing to confirm efficacy and safety of vilaprisan in long-term treatment of symptomatic fibroids. Expert opinion: It is fundamental to underline the rapidity of action (only 3 days) in the control of myoma-related bleedin

Repeated two cycles of ulipristal acetate treatment improve the quality of life in premenopausal women with heavy menstrual bleeding dependent on uterine myomas, without impairment of bone health

This observational study was conducted in premenopausal women who presented themselves at the Obstetrics and Gynecology Department of the University Hospital of Cagliari (Italy), for heavy menstrual bleeding (HMB) dependent on uterine myomas. After a screening visit, 19 women without contraindications to ulipristal acetate (UPA) treatment, were included in the study that envisaged 12months of observation in which each subject was asked to assume UPA (tablet of 5mg, ESMYA((R)), one tablet a day for 3months: first cycle) two menstrual cycles of interruption and a second ESMYA((R)) cycle, followed by 3months of observation (third follow-up month, visit 4). The significant decrease of myoma volume, diagnosed after the first ESMYA((R)) cycle, persisted until the visit 4. The HMB significantly decreased during the ESMYA((R)) treatment and persisted until visit 4. The quality of life (QoL), evaluated with the questionnaire SF-36, significantly improved during the study. The values of estradiol (E2), biochemical parameters of bone metabolism, as well as those of lumbar and hip bone mineral density, did not change during the study in comparison with basal levels. The efficacy of two repeated ESMYA((R)) cycles to treat uterine myomas and their related symptoms improves the QoL without interfering with bone health

The stimulation of the vaginal immune system with short-term administration of a vaginal gel containing fraction of <i>Propionibacterium acnes</i>, hyaluronic acid and polycarbophil is efficacious in vaginal infections dependent on disorders in the vaginal ecosystem

<p>The vaginal immune system (VIS) is the first defense against antigens recognized as foreign. Substances capable of locally activating the VIS could be a valid strategy to treat vulvo-vaginal infections (VVI), caused by changes in the vaginal ecosystem, such as bacterial vaginosis (BV), vulvo-vaginal candidiasis (CA), and mixed vaginitis (MV). Bacterial lysates, obtained by crushing bacterial cultures, exert immuno-modulatory activities. The parietal fraction from <i>Propionibacterium acnes</i> is a patent of Depofarma (MoglianoVeneto, Italy). The preparation that associates such fraction to hyaluronic acid and polycarbophil is a registered trademark, commercially available in Italy as vaginal gel, Immunovag^®. The study aimed to evaluate whether a 5-day-treatment with Immunovag^® improves the symptoms and signs of VVI, in 60 women with <i>Gardnerella vaginalis</i> (GV), 154 with CA, 95 with MV, diagnosed with vulvar vaginal swab (VVS), and in 283 with BV, diagnosed with the Amsel criteria. At the end of the treatment (visit 2), the symptoms and signs of VVI disappeared in a significant number of subjects (χ²<i>p</i> < .02 <i>vs</i> pre-treatment) in all VVI groups, and their intensity was significantly (<i>p</i> < .0002) reduced in the subjects in which they were still present. Immunovag^® represents a valid treatment of VVI induced by changes in the vaginal ecosystem.</p