The role of combined oral contraceptives in the management of acne and seborrhea

Acne and seborrhea (or facial oiliness) are related androgenic skin disorders which affect a high proportion of women after menarche. They can have a negative effect on psychological well-being and social life. Androgens play an important role in the pathogenesis of acne through the stimulation of sebum secretion, increasing sebaceous gland size and possibly through follicular hyperkeratinization. Conversely, estrogens decrease sebum production by suppressing gonadotropin release and androgen production and increasing sex hormone binding globulin production.

One of the treatment options for these conditions is hormonal therapy, especially for women who require contraception. The effect of combined oral contraceptives in androgenic skin disorders depends on their estrogen?:?progestogen balance and on the antiestrogenic activity of the progestogen component.

Improved understanding of what women value about oral contraceptives suggests that the choice of product should be tailored as much as possible to the individual. Several combined oral contraceptives containing new-generation progestogens (e.g. desogestrel, gestodene) or progestational antiandrogens (e.g. cyproterone acetate, chlormadinone acetate) have demonstrated efficacy in the treatment of women with acne, although comparisons between trials are difficult because of differing endpoints. Seborrhea has been less well studied, but the few studies that are available show an improvement in women with this condition using combined oral contraceptives.     

A comparison of the cycle control and tolerability of two ultra low-dose oral contraceptives containing 20 μg ethinylestradiol and either 150 μg desogestrel or 75 μg gestodene

Objective To compare the cycle control and tolerability of two oral contraceptives containing 20 μg ethinylestradiol and either 150 μg desogestrel or 75 μg gestodene.

Methods A randomized, multicenter study was conducted in which 1016 healthy adult women received the desogestrel (n = 509) or the gestodene (n = 507) preparation for six treatment cycles.

Results No significant differences in bleeding patterns were detected between the two treatments. The incidence and duration of irregular bleeding decreased markedly, and to a similar extent, during each treatment. The occurrence of irregular bleeding per cycle decreased from 24.6 to 9.4% in the desogestrel group and from 19.7 to 8.6% in the gestodene group. Its duration fell from 1.1 to 0.2 days and from 0.9 to 0.3 days, respectively. There was a consistently low incidence of amenorrhea (1.0–2.8%). There were no significant differences between treatments for the incidence, intensity or emergence of dysmenorrhea. During both treatments, the incidence of premenstrual syndrome and complaints such as breast tenderness, nausea and headache dropped markedly.

Conclusion Ultra low-dose oral contraceptives containing desogestrel or gestodene offer equivalent, good cycle control and improvements in dysmenorrhea and premenstrual syndrome and have similar, excellent tolerability profiles.     

产妇安合剂联合妈富隆预防人流术后宫腔黏连临床观察

目的:观察产妇安合剂联合妈富隆预防人流术后宫腔黏连的疗效。方法:选择2010年5月—2011年2月我院门诊人工流产患者180例,随机分成两组:治疗组100例,于术后当日开始给予短效口服避孕药妈富隆片,每晚1片口服,连服21天;同时加服产妇安合剂,每日2次,每次25mL。对照组80例:于术后当日开始给予短效口服避孕药妈富隆片,每晚1片口服,连服21天。结果:治疗组术后阴道出血量和持续时间,腹痛情况,月经周期、月经量、宫腔黏连等情况与对照组相比有差异(P<0.05)。结论:在人工流产术后服用产妇安合剂联合妈富隆,能明显减少术后阴道出血的天数,减少阴道出血量,减轻腹痛情况,有效恢复月经周期并预防宫腔黏连。     

人工流产术后及时服用短效避孕药的临床观察

目的:了解人工流产手术后及时服用短效避孕药的效果。方法:随即选取门诊孕早期行人工流产患者200例分为观察组和对照组各100例,两组术后均口服抗生素3天,同时观察组手术当日即开始服用去氧孕烯炔雌醇片,连用21天;观察两组术后出血时间、出血量、月经复潮时间、经量、经后宫腔镜评价宫腔形态。结果:观察组术后出血时间及出血量均少于对照组,差异有统计学意义(P<0.05);观察组月经复潮时间(28.1±4.2)天,对照组(33.4±7.1)天,差异有统计学意义(P<0.05),两组经量差异无统计学意义(P>0.05);观察组宫腔粘连2例,对照组9例,两组差异有统计学意义(P<0.05),对照组3例月经未复潮再次妊娠,观察组月经复潮前无再次妊娠。结论:人工流产后及时服用短效避孕药,不仅可以有效避孕,亦可以减少术后出血时间及出血量,维持正常月经周期,同时可预防宫腔粘连的发生。     

宫腔镜子宫内膜息肉电切术联合去氧孕烯炔雌醇治疗子宫内膜息肉36例临床观察

目的规察官腔镜子宫内膜息肉电切术联合去氧孕烯炔雌醇治疗子宫内膜息肉的临床疗效。方法官腔镜子宫内膜息肉电切术患者73例随机分为两组。单独官腔镜子宫内膜息肉电切术组（电切组）37例;宫腔镜子宫内膜息肉电切术联合去氧孕烯炔雌醇治疗组（联合组）36例,随访观察治疗效果。结果联合组月经改善、月经间期出血及子宫内膜息肉复发率均优于电切组,两组比较差异具有统计学意义（P〈0．05）。结论宫腔镜子宫内膜息肉电切术联合去氧孕烯炔雌醇治疗子宫内膜息肉具有较好的疗效。     

去氧孕烯炔雌醇治疗青春期功能失调性子宫出血疗效分析

目的：观察去氧孕烯炔雌醇治疗青春期功能失调性子宫出血（青春期功血）的临床疗效及不良反应。方法将确诊的86例青春期功血患者按照就诊先后分为治疗组和对照组各43例,对照组给予结合型雌激素（倍美力）治疗,治疗组给予去氧孕烯炔雌醇治疗。观察两组的止血效果及药物不良反应。结果治疗组痊愈率为65．1％,对照组为23．3％,两组差异有统计学意义（χ2＝15．28,P＜0．01）;治疗组止血时间为（33．24±12．85）h,短于对照组的（50．31±16．32）h（t＝5．39,P＜0．05）;两组不良反应发生率差异无统计学意义（χ2＝0．49,P＞0．05）。结论去氧孕烯炔雌醇治疗青春期功血的疗效确切,不良反应发生率低,患者接受程度高。     

新生化颗粒联合去氧孕烯炔雌醇片用于人工流产后计划生育服务的疗效观察?

目的评价新生化颗粒联合去氧孕烯炔雌醇片用于人工流产后计划生育服务的疗效。方法将140例要求人工流产的早孕妇女随机分成治疗组(70例)和对照组(70例)。治疗组人工流产术后当日起服用新生化颗粒2袋/次,2次/d,连服7 d,同时口服去氧孕烯炔雌醇片,1片/次,1次/d,连服21 d;对照组人工流产后仅口服新生化颗粒,用法、用量和时间同治疗组。观察两组阴道出血量、出血时间、月经复潮时间、月经恢复情况和并发症发生情况。结果治疗组的阴道出血量明显少于对照组(P<0.05),阴道出血时间和月经复潮时间均短于对照组(P<0.05),治疗组月经周期恢复情况优于对照组,且并发症发生率低于对照组。结论人工流产后即时应用新生化颗粒联合去氧孕烯炔雌醇片能有效减少患者阴道出血量,缩短出血时间,促进月经周期恢复及降低并发症。     

联合激素用药口服治疗106例围绝经期功血的疗效分析

目的探讨应用联合激素用药治疗106例围绝经期功血的临床治疗效果。方法 141例围绝经期功血患者随机分为三组,屈螺酮+炔雌醇组(优思明组),n=56;去氧孕烯+炔雌醇组(妈富隆组),n=50;炔诺酮组(妇康片组),n=35。各组分别按疗程进行口服优思明、妈富隆或妇康片,观察时间为3个周期,了解其疗效和副作用情况。结果优思明组、妈富隆组疗效明显优于妇康片组,但前两者疗效无明显差异。结论口服优思明和妈富隆疗效治疗围绝经期功血具有良好效果,短期治疗时间内两者的疗效无明显差别。     

Antihistamine-resistant Angioedema in Women with Negative Family History: Estrogens and F12 Gene Mutations

Background

In women with sporadic recurrent angioedema with an unknown cause who are unresponsive to antihistamines and have normal C1 inhibitor activity and a negative family history of angioedema, it is unclear whether they have idiopathic angioedema or hereditary angioedema with normal C1 inhibitor, and what impact exogenous estrogens have on their angioedema.

Methods

A cohort of 147 women was analyzed for F12 exon 9 mutations and for the influence of oral contraceptives, hormonal replacement therapy, and pregnancy on their angioedema.

Results

A total of 142 women had idiopathic angioedema unresponsive to antihistamines. Five women had an F12 mutation and thereby hereditary angioedema with F12 mutations. Among the women with idiopathic angioedema, 63 had never taken estrogens. There was no estrogen impact in 42 women, a moderate impact in 15 women, and a severe impact in 22 women. The type and dose of estrogens did not differ in women with and without an estrogen impact. In 5 women, idiopathic angioedema disappeared after desogestrel use. Among the 5 women with hereditary angioedema with F12 mutations, angioedema symptoms occurred during 4 pregnancies, whereas no symptoms occurred during any of the 58 pregnancies in women with idiopathic angioedema.

Conclusions

Women with recurrent angioedema unresponsive to antihistamines may have idiopathic angioedema or, more rarely, hereditary angioedema with F12 mutations. Both conditions may be provoked or aggravated by exogenous estrogens. In idiopathic angioedema, treatment with progestins may be helpful.     

Efficacy and safety of a 28-day oral contraceptive with 7 days of low-dose estrogen in place of placebo

BACKGROUND: The study was conducted to evaluate the efficacy and safety for the prevention of pregnancy of a 28-day oral contraceptive (OC) containing 150 mcg desogestrel (DSG)/20 mcg ethinyl estradiol (EE) for 21 days followed by 7 days of 10 mcg EE (Cette-28). STUDY DESIGN: A 6-month, prospective, multicenter, single-arm study was conducted in 1302 women aged 18-45 years. RESULTS: Over six cycles of treatment, the cumulative risk of pregnancy among all treated subjects (n=1262) was 0.9%. The Pearl Index for women 18-35 years of age (n=1042) was 2.20, including 9 pregnancies with estimated conception dates during active drug ingestion or up to 7 days after the last combination tablet. The rate of unscheduled bleeding was low and the duration of scheduled bleeding was approximately 2 days during each of the six treatment cycles. The safety profile was similar to what has been reported for other OCs. CONCLUSION: This low-dose, 28-day OC incorporating 7 days of 10 mcg EE during the hormone free interval is effective and safe for the prevention of pregnancy and is well-tolerated by women.