isge gynecology
ABSTRACTS - Symposia - Schering
schering
MODERN CONTRACEPTION FOR A BETTER QUALITY OF LIFE
ORAL CONTRACEPTIVE AND ACNE TREATMENT IN ONE:
DIANE-35


Adolf E. Schindler
Dept. Obstetrics and Gynecology, University of Essen, Germany

The clinical use of cyproterone acetate (CPA) - the most potent antiandrogenic progestin - was initiated 1970 in combination with ethinylestradiol (EE). Starting with the reversed biphasic regimen gradually a very effective hormonal tool for the treatment of sions of androuenisation in women and a most effective contraceptive has emerged using 2 mg of CPA and 0.035 mg of EE (Diane-350). Since ovulation inhibition is already accomplished with 1 mg CPA/day, Diane-35 suppresses the hypothalamic-pituitary-ovarian-axis reliable, which results in a very low Pearl index (0.1). This also leads to an excellent cycle control and bleeding pattern. In addition, Diane-35 has multifactorial antiandrogenic effects: 1. Competition at the cellular androgen receptor level. 2. Increasing androgen metabolic clearance at the hepatic level and reducing the activity of 5-alpha reductase at the skin level. 3. Being antigonadotropic leads to suppression of ovarian androgen secretion. 4. Increasing SHBG and decreasing free testosterone. This causes the desired clinical effects after 6 months of treatment: 1. Normalisation of acne 73%, seborrhoea 73.4%, after 12 months: acne 90.6%, seborrhoea 87.4%. The strong long-term positive metabolic effects need to be taken into account: 1. Favourable effects on carbohydrate metabolism. 2. Favourable effects on lipid metabolism. Long-term use of Diane-35 has no negative effect on liver function and does not increase the risk of liver cancer.
INTRODUCING THE NEW OC YASMIN WITH THE NOVEL PROGOESTOGEN THE SPECIAL ADVANTAGES OF A CONTRACEPTIVE WITH ANTIMINERALOCORTICOID AND ANTIANDROGENIC ACTIVITIES


J.M. Foidart MD, PhD
Dept. of Gynecology, University of Liège, LIEGE, BELGIUM

Drospirenone is a novel progestogen which differs in important ways from other currently available progestogens. It has a pharmacological profile that is very similar to natural progesterone. Drospirenone is not only strongly progestogenic but it also has antimineralocorticoid and antiandrogenic activities. An OC containing Drospirenone ha therefore the potential to counteract fluid retention resulting from the mineralocorticoid activity of ethinylestradiol, and therefore avoid or reduce any problems associated with fluid retention such as weight gain.
Two large, randomized, multicenter, open-label. clinical studies investigated the contraceptive efficacy and tolerance of Yasmin, a new oral contraceptive containing 30 μg ethinylestradiol plus 3 mg Drospirenone (28,000 cycles. Both preparations provided effective contraception excellent Pearl indexes and cycle control. Their influences on haemostasis parameters, lipid and carbohydrate metabolism was minimal. Pre-existing acne and seborrhea were improved and blood pressure was essentially unchanged. Yasmin provided effective contraception, (0.09 corrected Pearl Index), excellent cycle control and tolerance.
However, Yasmin had a more favorable effect on body weight than Marvelon, with the mean body weight remaining lower than baseline throughout the study, the difference between the two preparations being statistically significant.
In conclusion, Yasmin provides effective contraception, excellent cycle control, good tolerability and a weight loss that confers a significant beneficial effect on compliance in women with tendency to weight gain due to water retention.
In order to quantify the effect on well-being, a quality of life (QOL) survey was carried out (Yasmin n= 180). The respondents who had taken Yasmin during the trial rated their weight their disposition before and during menstruation, as well as their skin and hair conditions better with Yasmin than without this innovative OC.
This perception of Yasmin as having a positive effect on overall well-being is likely to reflec the antimineralocorticoid and antiandrogenic activities of Drospirenone. In consequence, it can be anticipated that general satisfaction with oral contraception, and therefore compliance may be enhanced.
THE INTRAUTERINE SYSTEM (IUS) MIRENA: LONG-ACTING CONTRACEPTION WITH ADDED BENEFITS

Pekka Lähteenmäki, MD, PhD

The levonorgestrel intrauterine system (LNG IUS, Mirena®) is a long‑acting hormonal method, which releases 20 pg/24 h of LNG into uterine cavity. It provides highly effective contraception for 5 years with a Pearl rate of 0. 1. In addition to postmenstrual insertion the LNG IUS can be inserted also directly after first trimester abortion or six weeks after delivery. The incidence of ectopic pregnancies is only one in 5.000 users annually. Only very low blood concentrations of LNG are measured. Therefore, the hormonal side effects are relatively rare. The LNG IUS is completely reversible method of contraception. The high degree of satisfaction is reflected by high first year continuation rates of 80 %. The LNG IUS reduces menstrual blood loss by inactivating the growth of endometrium. It can be used effectively as a treatment for menorrhagia. The studies show it reducing the need for hysterectomy due to menorrhagia. Total local amenorrhea is successful in 20 % of the users after 12 months. The reduction in the number of days of menstrual bleeding increases the quality of life. The LNG IUS has been shown to decrease dysmenorrhea. As with oral contraceptives, LNG IUS decreases the incidence of pelvic inflammatory disease. One large study demonstrates a decrease in the development of fibroids in LNG IUS users.
PATIENT COUNSELLING ON JUS - A LOCAL EXPERIENCE

Dr. Sue ST Lo, MBBS, MRCOG
The Family Planning Association of Hong Kong

The levonorgestrel - releasing intrauterine system (IUS) had been used in many countries in the past 30 years. Clinical trials had shown that the device is a highly effective contraceptive and severe complications are rare. Despite its high clinical efficacy, the IUS is not a popular contraceptive. In Hong Kong, less than 5% of women who had ever practiced contraception had used intrauterine contraceptive device (IUCD). The proportion of women using IUS was even lower. There is a general fear about putting a foreign object in the uterus and myths about IUCD were still prevalent. For the IUS, there were additional concerns for menstrual disturbance. Great difficulties had been encountered during the recruitment for an acceptability study on IUS. In the initial 6 months of recruitment, we had approached 57 eligible women, only 19 women agreed to use the IUS. The reasons for rejecting IUS were: disliked irregular spotting (40.5%), preferred other IUCD (19%), disliked amenorrhea (16.7%) and preferred other methods (16.7%). Among 48 successful insertion of IUS, 2 subjects had their IUS expulsed on day 26 and 3 months, both said they would wanted a re-insertion if given the opportunity. Four subjects requested removal, none was for spotting or amenorrhoea. The acceptability and continuation rate were high if subjects had been thoroughly counseled on the effects of IUS and they accepted the method.
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