Medroxyprogesterone Acetate

ObjectiveTo assess the association between risk of venous thromboembolism and use of different types of hormone replacement therapy.DesignTwo nested case-control studies.SettingUK general practices contributing to the QResearch or Clinical Practice Research Datalink (CPRD) databases, and linked to hospital, mortality, and social deprivation data.Participants80 396 women aged 40-79 with a primary diagnosis of venous thromboembolism between 1998 and 2017, matched by age, general practice, and index date to 391 494 female controls.Main outcome measuresVenous thromboembolism recorded on general practice, mortality, or hospital records. Odds ratios were adjusted for demographics, smoking status, alcohol consumption, comorbidities, recent medical events, and other prescribed drugs.ResultsOverall, 5795 (7.2%) women who had venous thromboembolism and 21 670 (5.5%) controls had been exposed to hormone replacement therapy within 90 days before the index date. Of these two groups, 4915 (85%)and 16 938 (78%) women used oral therapy, respectively, which was associated with a significantly increased risk of venous thromboembolism compared with no exposure (adjusted odds ratio 1.58, 95% confidence interval 1.52 to 1.64), for both oestrogen only preparations (1.40, 1.32 to 1.48) and combined preparations (1.73, 1.65 to 1.81). Estradiol had a lower risk than conjugated equine oestrogen for oestrogen only preparations (0.85, 0.76 to 0.95) and combined preparations (0.83, 0.76 to 0.91). Compared with no exposure, conjugated equine oestrogen with medroxyprogesterone acetate had the highest risk (2.10, 1.92 to 2.31), and estradiol with dydrogesterone had the lowest risk (1.18, 0.98 to 1.42). Transdermal preparations were not associated with risk of venous thromboembolism, which was consistent for different regimens (overall adjusted odds ratio 0.93, 95% confidence interval 0.87 to 1.01).ConclusionsIn the present study, transdermal treatment was the safest type of hormone replacement therapy when risk of venous thromboembolism was assessed. Transdermal treatment appears to be underused, with the overwhelming preference still for oral preparations.

Access to effective affordable contraception is critical for individual and public health. A wide range of hormonal contraceptives (HCs), which differ in composition, concentration of the progestin component, frequency of dosage, and method of administration, is currently available globally. However, the options are rather limited in settings with restricted economic resources that frequently overlap with areas of high HIV-1 prevalence. The predominant contraceptive used in sub-Saharan Africa is the progestin-only three-monthly injectable depot medroxyprogesterone acetate. Determination of whether HCs affect HIV-1 acquisition has been hampered by behavioral differences potentially confounding clinical observational data. Meta-analysis of these studies shows a significant association between depot medroxyprogesterone acetate use and increased risk of HIV-1 acquisition, raising important concerns. No association was found for combined oral contraceptives containing levonorgestrel, nor for the two-monthly injectable contraceptive norethisterone enanthate, although data for norethisterone enanthate are limited. Susceptibility to HIV-1 and other sexually transmitted infections may, however, be dependent on the type of progestin present in the formulation. Several underlying biological mechanisms that may mediate the effect of HCs on HIV-1 and other sexually transmitted infection acquisition have been identified in clinical, animal, and ex vivo studies. A substantial gap exists in the translation of basic research into clinical practice and public health policy. To bridge this gap, we review the current knowledge of underlying mechanisms and biological effects of commonly used progestins. The review sheds light on issues critical for an informed choice of progestins for the identification of safe, effective, acceptable, and affordable contraceptive methods.

Endometrial cancer (EC) is a deleterious condition which strongly affects a woman's quality of life. Although aggressive interventions should be considered to treat high-grade EC, a conservative approach should be taken into consideration for women wishing to conceive. In this scenario, we present an overview about the EC fertility-sparing approach state of art. Type I EC at low stage is the only histological type which can be addressed with a fertility-sparing approach. Moreover, no myometrium and/or adnexal invasion should be seen, and lymph-vascular space should not be involved. Regarding the pharmaceutical target, progestins, in particular medroxyprogesterone acetate (MPA) or megestrol acetate (MA), are the most employed agent in conservative treatment of early-stage EC. The metformin usage and hysteroscopic assessment is still under debate, despite promising results. Particularly strict and imperious attention should be given to the follow-up and psychological wellbeing of women, especially because of the double detrimental impairment: both EC and EC-related infertility consequences.

BackgroundSelf-care interventions, including contraceptive self-injectables such as subcutaneous depot medroxyprogesterone acetate (DMPA-SC), are hypothesized to be empowering to users. It is also believed that those who are empowered are more likely to use self-care. Though critical for ensuring equity of these interventions, evidence for the relationship between empowerment and contraceptive self-care is scant. However, studying this relationship is challenging. In addition to the potential reversed causality between these two constructs, empowerment is determined by similar factors as the motivation for using self-care, contributing to an endogeneity problem. If not addressed, endogeneity can lead to incorrect causal assertions.MethodsUsing data from a study of 400 women in Addis Ababa, Ethiopia who opted to self-inject DMPA-SC, we assessed the directionality between the two constructs. First, we assessed the change in empowerment after participants' first self-injection. Second, we assessed the effect of empowerment on potential future use of self-injection. To address potential endogeneity, we identified instrumental variables of empowerment and then applied a two-stage regression approach to predict desire to continue self-injecting at follow-up with an instrument for empowerment, controlling for other variables.ResultsEmpowerment scores among the 343 women who were followed-up were high and did not significantly change from baseline to endline. Most women (78%) wanted to continue self-injecting. The following variables were identified and used as instruments: religion, employment status and post-secondary school attendance. The final model did not identify a significant relationship between desire to continue self-injecting and empowerment. The test of exogeneity was marginally significant (p = 0.08).ConclusionsWe did not find evidence of a significant relationship between reproductive empowerment and desire to continue self-injecting. Though there are limitations to this secondary data analysis, we recommend future research investigate this relationship using the methodology demonstrated to address endogeneity inherent in answering this critical question about self-care interventions.