The Endometrium As A Target For Contraception

This book is a summary of the present state of the art in the physiology of both endometrial receptivity and implantation. Although these physiological processes are today considered as limiting factors responsible for both infertility and low gestation rates in patients undergoing assisted reproductive techniques, they may, on the other hand, represent future targets for contraception. Several aspects of endometrial receptivity and implantation are discussed in this book. In the first part, basic aspects of the cell biology of endometrial functions as well as the molecular aspects of endometrial receptivity and implantation are discussed. Subsequently the clinical and experimental approaches to endometrial contraception are considered. Finally, some basic questions are raised pointing to the need for further research in order to gain a better understanding of the implantation process and the development of new contraceptive strategies, including the inhibition of endometrial receptivity. The organizers of the workshop and the editors of the volume hope that this book will encourage both universities and the pharmaceutical industry to initiate and/or continue research on endometrial receptivity and implantation.

Combined oral contraceptives are the most convenient and accepted method of hormonal contraception. Nevertheless, the medical community and consumers constantly demand innovation, additional benefits during use and lower hormonal load despite the high safety profile of available products. At the Ernst Schering Research Foundation Workshop 52, new perspectives and mechanisms for tissue-selective, estrogen-free contraception were discussed. The aim of the workshop was to bring together experts in the field of molecular and pharmacodynamic action of progestins with clinicians and medical experts to discuss potential medical endpoints, physiological reactions and (bio)marker useful describing the tissue selectivity and the contraceptive action of new progestins in different target organs. A major factor for successful realization of these new concepts is a deeper understanding of local pharmacological responses to progestins in general and to new progestins in particular.

The "contraceptive revolution" of the 1960s and 1970s introduced totally new contraceptive options and launched an era of research and product development. Yet by the late 1980s, conditions had changed and improvements in contraceptive products, while very important in relation to improved oral contraceptives, IUDs, implants, and injectables, had become primarily incremental. Is it time for a second contraceptive revolution and how might it happen? Contraceptive Research and Development explores the frontiers of science where the contraceptives of the future are likely to be found and lays out criteria for deciding where to make the next R&D investments. The book comprehensively examines today's contraceptive needs, identifies "niches" in those needs that seem most readily translatable into market terms, and scrutinizes issues that shape the market: method side effects and contraceptive failure, the challenge of HIV/AIDS and other sexually transmitted diseases, and the implications of the "women's agenda." Contraceptive Research and Development analyzes the response of the pharmaceutical industry to current dynamics in regulation, liability, public opinion, and the economics of the health sector and offers an integrated set of recommendations for public- and private-sector action to meet a whole new generation of demand.

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.

More than a quarter of pregnancies worldwide are unintended. Between 1995 and 2000, nearly 700,000 women died and many more experienced illness, injury, and disability as a result of unintended pregnancy. Children born from unplanned conception are at greater risk of low birth weight, of being abused, and of not receiving sufficient resources for healthy development. A wider range of contraceptive options is needed to address the changing needs of the populations of the world across the reproductive life cycle, but this unmet need has not been a major priority of the research community and pharmaceutical industry. New Frontiers in Contraceptive Research: A Blueprint for Action, a new report from the Institute of Medicine of the National Academies, identifies priority areas for research to develop new contraceptives. The report highlights new technologies and approaches to biomedical research, including genomics and proteomics, which hold particular promise for developing new products. It also identifies impediments to drug development that must be addressed. Research sponsors, both public and private, will find topics of interest among the recommendations, which are diverse but interconnected and important for improving the range of contraceptive products, their efficacy, and their acceptability.

The Endometrium is devoted to a comprehensive multi-disciplinary account of the uterine endometrium. This book is the first to define the regulatory biological interrelationships between epithelial and stromal cell phenotypes, endothelial cells, extracellular matrix and immunobiological elements. It highlights their relevance to clinical conditions

This book describes a standardized method for classifying and reporting invasive endometrial malignancies via direct endometrial sampling. Featuring a wealth of color illustrations, it provides specific diagnostic categories and cytomorphologic criteria to promote uniform and reliable diagnoses. It also describes the history of directly sampled endometrial cytology, reviews the sampling techniques and algorithmic approach, discusses specimen adequacy, and outlines challenges for the future. The Yokohama System for Reporting Endometrial Cytology – Definitions, Criteria and Explanatory Notes offers a valuable resource for researchers at clinical cytopathological laboratories around the world whose work involves gynecological cytology, oncology, pathology, and cytopathology. It will also appeal to researchers in the fields of cytotechnology, basic science, pathology and related industries, medical residents and clinicians.