Tissue Concentrations of Levonorgestrel in Women Using a Levonorgestrel‐releasing Iud

Nilsson, Carl Gustaf; Haukkamaa, Maija; Vierola, H.; Luukkainen, Tapani

doi:10.1111/j.1365-2265.1982.tb01625.x

Cited by 200 publications

(103 citation statements)

References 16 publications

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“…When progesterone is given by intrauterine device, the effect on uterine mucosa is several times higher than that of oral ingestion [17]. In our study, endometrial thickness was significantly reduced in both groups, while endometrial thinning in the LNG-IUD group was more prominent (4.1 mm vs. 6.3 mm).…”

Section: Discussionsupporting

confidence: 47%

Levonorgestrel-releasing intrauterine device versus oral progesterone for treatment of simple endometrial hyperplasia without atypia

Kansu-Celik¹,

Karakaya²,

Evliyaoğlu³

et al. 2017

Med-Science

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The aim of this study was to compare the efficacy and effect on the menstrual pattern of the levonorgestrel releasing intrauterine device versus oral progesterone for treatment in patient having simple endometrial hyperplasia (EH) without atypia. Patients who underwent endometrial sampling with abnormal uterine bleeding history and received simple EH without atypia were included in this study between 1 December 2015 and 31 March 2016, retrospectively. Twenty-two patients were treated with the levonorgestrel-releasing intrauterine device (LNG-IUD) and 47 with oral progesterone. Primary outcome measures were regression of hyperplasia after 3 months of therapy. Secondary outcome measures were effect on menstruel pattern during treatment, or rates of hysterectomy and recurrence within a 12 month period. After 3 months of treatment, regression of EH occurred in all of women in LNG-IUD group versus 93% of women in the oral progesterone group (p=0.226). Hb values were increased at the 3th month measurement in both of groups. Endometrial thickness was significantly decreased at the end of the 3th month (p<0.001). Amenorrhea was more common in the LNG-IUD group (p<0 .001). Recurrence rate was similar in both of groups. Hysterectomy rate was 0% in the LNG-IUD group compared to 10% ın the oral progesterone group. LNG-IUD and oral progesterone seem to have similar efficacy in treatment of simple EH without atypia. LNG-IUD in patients who want to protect the uterus, oral progesterone therapy in patients who want to have regular menstruation with regular follw-up may be the first choice.

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Section: Discussionsupporting

confidence: 47%

Levonorgestrel-releasing intrauterine device versus oral progesterone for treatment of simple endometrial hyperplasia without atypia

Kansu-Celik¹,

Karakaya²,

Evliyaoğlu³

et al. 2017

Med-Science

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“…It causes stromal pseudodecidualization, glandular atrophy, decreased glandular and stromal mitoses, and leukocytic infiltration. 42 The LNG-IUD appears to have minimal effects on ovulation and breast milk production and does not markedly affect serum levels of E2, progesterone, or luteinizing hormone. 42,43 However, LNG is one of the most potent progestins and has high binding affinity for PRs.…”

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

“…42 The LNG-IUD appears to have minimal effects on ovulation and breast milk production and does not markedly affect serum levels of E2, progesterone, or luteinizing hormone. 42,43 However, LNG is one of the most potent progestins and has high binding affinity for PRs. 44 In addition, LNG strongly binds SHBG and lowers serum SHBG levels.…”

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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“…Outro progestógeno que deve ser considerado é o levonorgestrel (LNG), uma vez que é um dos componentes mais comuns das pílulas combinadas, além de também ser constituinte do sistema liberador intrauterino, que propicia concentração sérica do LNG 1000 vezes menor do que a intrauterina (Nilson 1982) 8 .…”

Section: Coment áRiounclassified

Sistema intrauterino liberador de levonorgestrel e risco de câncer de mama

Scapinelli¹,

Oliveira²,

Takagi³

et al. 2010

Rev. Assoc. Med. Bras.

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No último Congresso da Sociedade Européia de Contracepção e Saúde Reprodutiva, realizado em 2010 na Holanda, Dinger et al. apresentaram os resultados de um estudo que avaliou comparativamente o risco do câncer de mama em usuárias do sistema liberador ntra-uterino de levonorgestrel (SLIU/LNG) e do dispositivo intra uterino contendo cobre (DIU/Cu) 1 .O estudo identificou, entre 2000 e 2007 nos registros de cânceres da Alemanha e Finlândia, 5113 casos de câncer de mama em mulheres abaixo de 50 anos confirmados histologicamente e 20452 controles.Todas foram analisadas quanto às características pessoais e fatores de risco para câncer de mama, como IMC, história ginecológica, uso de contracepção hormonal e TH, história familiar de cânceres ginecológicos, presença de comorbidades, uso de fármacos, indicadores socioeconômicos e estilo de vida.A estatística se apoiou em testes com poder analítico de detectar o risco de câncer de mama acima de 1,5 vezes e se basearam em três diferentes modelos de regressão logística para avaliar 14 fatores confundidores.Os resultados obtidos foram símiles nos dois países, tanto nas ex como nas usuárias atuais dos dois grupos (SLIU/LNG e DIU/Cu) no tocante ao risco de câncer de mama invasivo, aparecimento de metástases regional ou distante, tamanho/ tipo histológico do tumor e prevalência dos fatores de risco.O estudo de Dinger et al. surge num momento oportuno, pois pode contribuir na resposta de uma questão ainda atual e que se tornou candente após a publicação dos resultados do WHI 2 , qual seja, a da possibilidade dos progestógenos se associarem a oncogênese mamária, uma vez que seu uso, quando combinado ao estrogênio, propiciou um maior risco do câncer de mama do que o observado com o estrogênio isolado.O WHI foi o primeiro estudo duplo cego randomizado, placebo controlado a relatar maior risco de câncer de mama aos 5,2 anos no grupo de usuárias da associação estrogênio conjugado equino (ECE) com o acetato de medroxiprogesterona (AMP); diferentemente no grupo de usuárias do ECE isolado, constatou-se redução do risco aos sete anos de uso do esteróide, porém sem significância estatística. Posteriormente, a progesterona durante a segunda fase do ciclo menstrual, bem como o uso de progestógenos, foram responsabilizados a uma ação mitogênica no epitélio mamário (Nazário 1995) 5 . Do exposto se depreende que todos esses estudos geram um embasamento biológico plausível que permite supor um possível impacto do esteroide no determinismo do câncer de mama.Certamente, foi por isso que logo após o WHI muitos estudos emergiram da literatura com o intuito de esclarecer os possíveis mecanismos dos progestógenos na eclosão da mitogênese mamária Um dos que tem sido muito estudado relaciona-se ao impacto dos progestógenos sobre as enzimas presentes no tecido mamário normal e naquele com câncer que apresentam importante participação na bioformação e transformação metabólica dos estrogênios, androgênios e progesterona; entre essas enzimas, destacam-se a sulfatase, aromatase, 17 β hidroxiesteroide dehidro...

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Tissue Concentrations of Levonorgestrel in Women Using a Levonorgestrel‐releasing Iud

Cited by 200 publications

References 16 publications

Levonorgestrel-releasing intrauterine device versus oral progesterone for treatment of simple endometrial hyperplasia without atypia

Levonorgestrel-releasing intrauterine device versus oral progesterone for treatment of simple endometrial hyperplasia without atypia

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Sistema intrauterino liberador de levonorgestrel e risco de câncer de mama

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