Progesterone And Progestins

Evaluates evidence for an increased risk of cancer in women using combined oral contraceptives, progestogen-only hormonal contraceptives, post-menopausal estrogen therapy, and post-menopausal estrogen-progestogen therapy. Although the carcinogenicity of these preparations has been extensively investigated, the book stresses the many complex methodological issues that must be considered when interpreting findings and weighing results. Evidence of an association between use of these preparations and positive effects on health, including a reduced risk of some cancers, is also critically assessed. The first and most extensive monograph evaluates evidence of an association between the use of combined oral contraceptives and cancer at nine sites. Concerning breast cancer, the evaluation concludes that, even if the association is causal, the excess risk for breast cancer associated with patterns of use that are typical today is very small. Studies of predominantly high-dose preparations found an increased risk of hepatocellular carcinoma in the absence of hepatitis viruses. Citing these findings, the evaluation concludes that there is sufficient evidence in humans for the carcinogenicity of combined oral contraceptives. The evaluation also found sufficient evidence for the carcinogenicity of some, but not all, combined preparations in animals. Combined oral contraceptives were classified as carcinogenic to humans. The evaluation also cites conclusive evidence that these agents have a protective effect against cancers of the ovary and endometrium. Progestogen-only contraceptives are evaluated in the second monograph, which considers the association with cancer at six sites. The evaluation found no evidence of an increased risk for breast cancer. Although the evaluation found sufficient evidence in animals for the carcinogenicity of medroxyprogesterone acetate, evidence for the carcinogenicity of progestogen-only contraceptives in humans was judged inadequate. Progestogen-only contraceptives were classified as possibly carcinogenic to humans. The third monograph, on post-menopausal estrogen therapy, considers evidence of an association with cancer at eight sites. Findings from a large number of epidemiological studies indicate a small increase in the risk of breast cancer in women who have used these preparations for five years or more. Studies consistently show an association between use of post-menopausal estrogen therapy and an increased risk for endometrial cancer. Data on the association with other cancers were either inconclusive or suggested no effect on risk. The evaluation concludes that post-menopausal estrogen therapy is carcinogenic to humans. The final monograph evaluates the association between the use of post-menopausal estrogen-progestogen therapy and cancer at four sites. The evaluation of limited data on breast cancer found an increased relative risk observed with long-term use. Data were judged insufficient to assess the effects of past use and of different progestogen compounds, doses, and treatment schedules. For endometrial cancer, the evaluation found an increase in risk relative to non-users when the progestogen was added to the cycle for 10 days or fewer. Post-menopausal estrogen-progestogen therapy was classified as possibly carcinogenic to humans. Concerning post-menopausal therapy in general, the book notes that evidence of carcinogenic risks must be placed in perspective of potential benefits. The prevention of osteoporotic fractures is cited as the best-established benefit. Evidence also suggests that estrogen prevents heart disease and may prevent memory loss and dementia.

Medical Eligibility Criteria for Contraceptive Use reviews the medical eligibility criteria for use of contraception, offering guidance on the safety and use of different methods for women and men with specific characteristics or known medical conditions. The recommendations are based on systematic reviews of available clinical and epidemiological research. It is a companion guideline to Selected Practice Recommendations for Contraceptive Use. Together, these documents are intended to be used by policy-makers, program managers, and the scientific community to support national programs in the preparation of service delivery guidelines. The fourth edition of this useful resource supersedes previous editions, and has been fully updated and expanded. It includes over 86 new recommendations and 165 updates to recommendations in the previous edition. Guidance for populations with special needs is now provided, and a new annex details evidence on drug interactions from concomitant use of antiretroviral therapies and hormonal contraceptives. To assist users familiar with the third edition, new and updated recommendations are highlighted. Everyone involved in providing family planning services and contraception should have the fourth edition of Medical Eligibility Criteria for Contraceptive Use at hand.

This document is one of two evidence-based cornerstones of the World Health Organization's (WHO) new initiative to develop and implement evidence-based guidelines for family planning. The first cornerstone, the Medical eligibility criteria for contraceptive use (third edition) published in 2004, provides guidance for who can use contraceptive methods safely. This document, the Selected practice recommendations for contraceptive use (second edition), provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. The recommendations contained in this document are the product of a process that culminated in an expert Working Group meeting held at the World Health Organization, Geneva, 13-16 April 2004.

Drug-Induced Liver Injury, Volume 85, the newest volume in the Advances in Pharmacology series, presents a variety of chapters from the best authors in the field. Chapters in this new release include Cell death mechanisms in DILI, Mitochondria in DILI, Primary hepatocytes and their cultures for the testing of drug-induced liver injury, MetaHeps an alternate approach to identify IDILI, Autophagy and DILI, Biomarkers and DILI, Regeneration and DILI, Drug-induced liver injury in obesity and nonalcoholic fatty liver disease, Mechanisms of Idiosyncratic Drug-Induced Liver Injury, the Evaluation and Treatment of Acetaminophen Toxicity, and much more. Includes the authority and expertise of leading contributors in pharmacology Presents the latest release in the Advances in Pharmacology series

Mifepristone (RU486), the first clinically available antiprogestin, has generated great interest since its discovery in the early 1980s. Today, it is recognized that mifepristone, along with other antiprogestins, has a potentially significant therapeutic role in human health and disease, with likely applicability to a variety of pregnancy-related conditions (e.g., management of labor) and to contraception, endometriosis, and cancer, among others. But because mifepristone has been studied and used most widely as a means of nonsurgical abortion, political issues have thus far limited research on the drug and prevented its introduction into the U.S. market. This book provides an unbiased evaluation of current knowledge about both the fundamental nature of antiprogestins as well as their possible use in treating numerous diseases and conditions, and it contains recommendations for future research.

These two volumes on Estrogens, Progestins, and Their Antagonists repre sent a thematic extension of the series, Hormones in Health and Disease. The first publication in the series, Steroid Hormone Receptors: Basic and Clinical Aspects, focused on recent advances in the anatomy of steroid receptors and members of the steroid receptor superfamily. Consistent with the spirit of the series, the authors addressed issues of clinical significance of steroid receptor detection in hormone-related disorders. The second volume in the series, Hormones and Cancer, attempted a more direct examination of ac tions of hormones in cancerous tissues and cells. In these two volumes, which together form the third in the series, the editor, Dr. Edward Pavlik, has introduced a team of leading investigators engaged in research on various aspects of the steroids that regulate female reproductive physiology. Estrogens and progestins, the main components of the most widely used contraceptive pills, have found a variety of uses in clinical endocrinology. These volumes contain discussions that range from the introduction of novel hormonal ligands to "hormonal antagonism by steroid analogs. A balanced treatment is provided of applications of the steroids in treatment and management of hormone-dependent conditions and malignancies. The remarkable synthesis of literature contained in this volume will provide a reader with both the fundamental concepts underly ing steroid hormone physiology and the clinical applications of observations made on basic aspects of hormone action. I congratulate the editorial leadership of Dr.

This comprehensive ready-reference guide thoroughly examines the physiological aspects of progestins and their role at the receptor level, focusing on reproductive activity, menopausal treatment, and related areas. The book presents vital research findings on the clinical use of progesterone and related derivatives, plus key applications of antiprogestins. Illuminates progesterone's remarkable power in hormonal contraception and regulation of the hypothalamo-pituitary complex! Written by more than 25 leading international experts on women's health, Progestins and Antiprogestins in Clinical Practice explains the effects of long-term controlled progestin studies on breast tissue discusses the nuclear localization of steroid hormone receptors covers the relationship of CDK activity and cell proliferation analyzes production of progesterone metabolites and precursors synthesized locally within the brain and in the endocrine glands describes cardiovascular effects associated with combined oral contraceptives (COCs), highlighting carbohydrate and lipid metabolism and hematological factors investigates the epidemiology of estrogen-induced endometrial hyperplasia and/or cancer demonstrates cases in which minor structural modifications in some steroid molecules can affect biological function explores several properties of progesterone and its natural derivatives illustrates instances of cloning of the intracellular progesterone receptor (PR) in several species assesses direct progesterone action in target tissues and indirect effects of progesterone regulation surveys properties of widely used contraceptive steroids, such as norethindrone (NET) plus estradiol (E2), levonorgestrel (LNG) plus estradiol (E2), nestorone plus ethinyl estradiol (EE2), and NET acetate plus EE2 reviews the efficacy and safety of newer contraceptive strategies such as Norplant implants and vaginal rings covers applications of RU486 (mifepristone) and more!