Ellis OralContraceptives

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Information about Ellis OralContraceptives
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Published on February 6, 2008

Author: Renzo

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EXTENDED USE OF ORAL CONTRACEPTIVES: MENSTRUAL NIRVANA :  EXTENDED USE OF ORAL CONTRACEPTIVES: MENSTRUAL NIRVANA Lisa LaFollette Ellis February 24 2003 Ambulatory Care Educational Block EXTENDED USE OF ORAL CONTRACEPTIVES :  EXTENDED USE OF ORAL CONTRACEPTIVES Goals : To present the usage and known benefits of standard-use oral contraceptives 2. To present a review of extended use oral contraceptives 3. To suggest future use of extended use oral contraceptives for effective treatment of PMS and menstrual cycle dependant depression Oral Contraceptives- Basic prevention use :  Oral Contraceptives- Basic prevention use Suppresses the FSH and LH secretion, preventing stimulation of GnRH. Prevents the maturation of ovarian follicles Thickens the cervical mucus which impedes sperm penetration Oral Contraceptives The Standard 21 Day Regimen:  Oral Contraceptives The Standard 21 Day Regimen 28 day cycle with 21 active and 7 hormone-free pills Induces a monthly withdrawal bleed Few problems with breakthrough bleeding Contraindications to using OCP's:  Contraindications to using OCP's Past hx of thromboembolic disorders CVA Breast Cancer Undiagnosed abnormal genital bleeding Hepatic adenomas or carcinomas Hypertension >35 and smoker Benefits of oral contraception:  Benefits of oral contraception CYCLE RELATED: Dysmenorrhea Menorrhagia Anemia Ovulation Dysfunctions Irregular cycles TREATMENT OF: Acne Hirsuitism PCO Rheumatoid arthritis Benefits of oral contraception:  Benefits of oral contraception PREVENTION OF: Fibrocystic Breast disease Pelvic inflammatory disease Ectopic Pregnancies Urogenital symptoms Endometriosis Benefits of Oral Contraception:  Benefits of Oral Contraception Prevention of Bone Loss Kleerekoper M, Brienza RS, Schultz LR, et al. Oral contraceptive use may protect against low bone mass. Henry Ford Hospital Osteoporosis Cooperative Research Group. Arch Intern Med. 1991;151:1971-1976. BENEFITS OF ORAL CONTRACEPTION:  BENEFITS OF ORAL CONTRACEPTION CANCER RELATED: Decrease in endometrial ca Ovarian Ca Colorectal Ca Schlesselman JJ. Risk of endometrial cancer in relation to use of combined oral contraceptives: a practitioner's guide to meta-analysis. Hum Reprod. 1997;12:1851-1863. HORMONE WITHDRAWAL SYMPTOMS IN OCP USERS:  HORMONE WITHDRAWAL SYMPTOMS IN OCP USERS 1. Headaches 2. Pelvic Pain/Cramps 3. Bloating and Swelling 4. Breast Tenderness 5. PMS Sulak et al.Hormone withdrawal symptoms in oral contraceptive users Obstetrics and Gynecology 2000. 95:261-6 Nuisance or natural and healthy:should monthly menstruation be optional for women?:  Nuisance or natural and healthy:should monthly menstruation be optional for women? Leading cause of gyn morbidity in the USA Affects nearly 2.5 million women annually Texas Instruments found a 25% reduction in the productivity of female workers Socialized and mythologized into being the unquestionable natural and normal state for women Nuisance or natural:  Nuisance or natural Monthly menstruation for decades on end is not the norm Foremothers had later menarche, earlier first births, frequent pregnancies and long periods of breastfeeding Approx 160 ovulations over a lifetime Currently menstruate earlier First birth later Fewer pregnancies Scarcely breastfeeds Later menopause Approx 450 periods in her life Thomas,Sarah, Nuisance or natural and healthy: Should monthly menstruation be optional for women? Lancet 2000 Vol 355 page 922-924 Nuisance or natural:  Nuisance or natural Classic 21/7 schedule designed to “mimic” the normal menstrual cycle, even though it was unnecessary Menses with OCP users does not resemble biological menstrual period Little built-up uterine lining to be shed. Bleeding results from drop in hormone levels Thomas,Sarah, Nuisance or natural and healthy: Should monthly menstruation be optional for women? Lancet 2000 Vol 355 page 922-924 EXTENDING THE DURATIONS OF ACTIVE OCP’S TO MANAGE HORMONE WITHDRAWAL SYMPTOMS:  EXTENDING THE DURATIONS OF ACTIVE OCP’S TO MANAGE HORMONE WITHDRAWAL SYMPTOMS 50 patients on OCP’s extended the number of consecutive active pills 6 consecutive weeks of pills Increased the interval by 3 weeks each cycle 74% stabilized on an extended regimen 26% were not stabilized secondary to breakthrough spotting and bleeding Sulak et al Extending the duration of OCP’s to manage hormone withdrawal symptoms, Obstet.Gynecol. 1997:89:179-183 “ACCEPTANCE OF ALTERING THE STANDARD 21 DAY/7 DAY ORAL CONTRACEPTIVE REGIMEN TO DELAY MENSES AND REDUCE HORMONE WITHDRAWAL SYMPTOMS” :  “ACCEPTANCE OF ALTERING THE STANDARD 21 DAY/7 DAY ORAL CONTRACEPTIVE REGIMEN TO DELAY MENSES AND REDUCE HORMONE WITHDRAWAL SYMPTOMS” Sulak, Patricia, et al. Acceptance of altering the standard 21-day/7 day Pral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. American Journal of Ob. Gyn. June 2002 186: Volume 6 STUDY DESIGN AND RESULTS:  STUDY DESIGN AND RESULTS 318 patients counseled on extending the number of active pills 292 followed for 7 years to determine if they continued the regimen Reasons for extending included headache, dysmenorrhea, and PMS, convenience, endometriosis and menstrual related acne RESULTS :  RESULTS 25 chose not to extend. Majority reported they were uncomfortable with idea of no monthly menses 267 extended 57- dc’d pills 38 - standard use 172- continued extended use Extended use was for 12 weeks (median 9 weeks with range to 104) Pill free interval of 6 +/- 2 days RESULTS:  86% of group that extended reported improvement in original problem 94% reported quality of life greatly improved No pregnancies No thromboembolic events RESULTS CLINICAL CASE :  CLINICAL CASE 34 year old AA female HPI: Suicidal ideation and severe depression, with timing noted to be associated only with her menstrual cycle. Noted for last 3 years PMHx: Choleycystectomy age 29 GERD G2P2 Depression with 1 suicide attempt CLINICAL CASE :  CLINICAL CASE Medications: Current: Nexium 20 qd Effexor 225mg Trazedone 150 qhs Buspar 15 mg bid Past: Prozac, Nortriptyline, Wellbutrin, Paxil PMS:  PMS PMS:  PMS A condition caused by natural hormonal fluctuations which tends to intensify in last days before menstruation Characterized by fatigue, backache, decrease in libido, difficult concentrating, irritability, anxiety, and depression SERAFEM:  SERAFEM STUDIES REVIEING THE USE OF OCP’S FOR PMS SYMPTOMS :  STUDIES REVIEING THE USE OF OCP’S FOR PMS SYMPTOMS “The impact of OCP’s on PMS,clumsiness,food craving and other symptoms” “The relationship between PMS and OCP use: a a controlled study” “The OCP’s in premenstrual syndrome: a randomized comparison of triphasic and monophasic preparations” “The relationship between mood and sexuality using OCP’s as a treatment for premenstrual symptoms” ESTRADIOL PATCH AS AN ANTIDEPRESSANT:  ESTRADIOL PATCH AS AN ANTIDEPRESSANT 50 Perimenopausal women aged 40-55 26 met DSM-IV criteria for major depressive, 13 for minor depressive and 11 for dysthymia Randomized in double blinded fashion for 12 weeks of patches with estradiol or placebo Full remission was documented using a depression rating scale in 17 of 25 women on estradiol compared with 5 on placebo Soares CN - Arch Gen Psychiatry - 01-Jun-2001; 58(6): 529-34 Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Slide26:  Dear Lisa We are currently preparing a prospective study on patients with PMS who will extend the active pills. Anecdotally, in my large clinical practice, patients swear by it. No menses - - no PMS. I think extended pill regimens will soon be standard and they will decrease many of the hormone withdrawal symptoms that are so common: menstrual migraines, cramps, PMS, etc. Good Luck PJ SULAK MD PS: Tell Dr Klein I said hello. seasonale:  seasonale Developed by EVMS, manufactured by Barr Labs Low dose estrogen/progestin 91 day cycle with 84 active pills and 7 placebo 1 year trial with 1376 patients Effective at preventing pregnancy No adverse effects Estimated 3 billion dollars saved in sanitary products 4 periods per year !!! QUESTION TO PONDER: :  QUESTION TO PONDER: COULD EXTENDED USE OF OCP’S BE UTILIZED WITH MY PATIENT? WHAT SAFETY ISSUES ARISE WITH THIS PRACTICE? AM I USING EVIDENCE BASED MEDICINE TO TREAT MY PATIENT? DO WOMEN NEED A MEDICAL INDICATION TO AVOID MONTHLY MENSTRUAL BLEEDING? SUMMARY :  SUMMARY OCP’s have been utilized safely and effectively for years OCP’s have proven to be beneficial for a variety of cycle and non-cycle related conditions Continuous use of OCP’s to achieve amenorrhea for a number of reasons has been looked at for acceptance in the users and relief of symptoms SUMMARY:  SUMMARY OCP’s have been used effectively to treat mood and PMS condition It may be speculated that extended OCP’s regimens may be beneficial to patients with major/minor depression related to the menstrual cycling of hormones Menstrual Nirvana:  Menstrual Nirvana “It may not be for all, but at the very least, health professionals and women should know about the option and its potential benefits” David Grimes, MD University of Northern California, business Week May 23, 2002 References and Resources :  References and Resources 1. NB Loudon, M Foxwell Acceptability of an oral contraceptive that reduces the frequency of menstruation BMJ 1977 2:487-490 2. E. Coutinho, E Odwyer, Comparative study on intermittent versus continuous use of a contraceptive pill Contraception 1995, 51:355-358 3. H, Kornatt,MH GeerdinkThe acceptance of a 7 week cycle with a modern low-dose oral contraceptive Contraception 1992 45: 119-127 4. P. Sulak, BE Cressman, E Waldrop Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms Obstet Gynecol 1997 89:179-183 5. Graham CA, Sherwin BB The relationship between retrospective premenstrual symptom reporting and present ocp use Journal of Psychosomatic Research 1987; 31 (1): 45-53 References and Resources :  References and Resources 6. Sulak,PJ,Scxow RD Hormone withdrawal symptoms in oral contraceptive users Obstetric Gynecol 2000 Feb; 95(2):261-6 7. Bancroft J, Rennie D. The impact of OCP’s on the experience of premenstrual mood, clumsiness, food craving and other symptoms Journal of Psychosomatic Research 1993; 37(2):195-202 8.Edelman A Menstrual nirvana:amenorrhea through the use of continuous oral contraceptives Curr Women’s Health Report 2002 Dec;2(6):434-8 9. Sulak PJ,Kuehl TJ Acceptance of altering the standard 21-day/7day OCP regimen to delay menses and reduce hormone withdrawal symptoms. Am Journal of Ob Gyn 2002 Jun;186(6):1142-9 10 ECG Grant: Dangers of suppressing menstruation Lancet 2000, 356:513-514 References and Resources:  References and Resources 11. Hazes JMW, VanZeben D. Oral contraception and its possible protection against rheumatoid arthritis. Ann Rheum Dis. 1991;50:72. 12. Apgar BS. Dysmenorrhea and dysfunctional uterine bleeding. Primary Care: Clinics in Office Practice. Mar 1997(24):161-78. 13. Hazes JM, Dijkmans BC, Vandenbroucke JP, et al. Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives. Arthritis Rheum. 1990;33:173. 14. Lucky AW, Henderson TA, Olson WH, et al. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris. J Am Acad Dermatol. 1997;37:746. 15 Kuohung W, Borgatta L, Stubblefield P. Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception. 2000;61:77-82. References and Resources:  References and Resources 16. Soares CN - Arch Gen Psychiatry - 01-Jun-2001; 58(6): 529-34 Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial.

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