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16 Sumatriptan (50 mg tablets vs 25 mg suppositories) in the acute treatment of menstrually-related migraine and oral contraceptive-induced menstrual migraine: a pilot study

Bellafronte, Manuela, Facchinetti, Fabio; Allais, Gianni; Nappi, R.; Gabellari Castagnoli, Ilaria; Di Renzo, GC; Genazzani, Andrea R; Roncolato, Maurizio; Benedetto, Chiara DGYE-2009-0276

Migraine attacks are common in the perimenstrual period (menstrually-related migraine, MRM) and can be particularly exacerbated by the cyclic suspension of oral contraceptives (oral contraceptive-induced menstrual migraine, OCMM). This cross-over, randomised study evaluated the efficacy and tolerability of rectal (25 mg) and oral (50 mg) sumatriptan in the treatment of 232 menstrual migraine attacks (135 MRM and 97 OCMM). more

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Metabolic actions of hormonal contraceptives

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Metabolic actions of hormonal contraceptives
Serfaty David

(14th World Congress of Gynecological Endocrinology – March 4-7 2010)

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Suleyman, Halis DGYE-2009-0186 [ID 451584]

Research on female sex hormones has demonstrated that estrogen aggravates epileptogenesis. This theoretically means that the frequency of epileptic attacks should be decreased in epileptic women during menopause. However, although epilepsy attacks are reported to decrease in some women during menopause, in others they may not change. Increases in attack frequency have even been reported during menopause in some epileptic women. This study has investigated the effects of estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) on caffeine-induced epileptiform activity in rats. Estrogen was found to increase epileptiform activity in a dose-dependent manner via its own receptors. In contrast, progesterone had no effect on epileptiform activity. FSH and LH suppressed epileptiform activity at low doses; however, at high doses they enhanced it. In conclusion, we suggest that the occurrence or aggravation of epilepsy, in spite of estrogen deficiency in the menopausal or post-menopausal period, is related to excessive accumulation of FSH and LH.

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1) Fertil Steril. 2010 Jan;93(1):21-8.

Gracia CR, Sammel MD, Charlesworth S, Lin H, Barnhart KT, Creinin MD.

OBJECTIVE: To assess sexual function of first-time users of the contraceptive ring and contraceptive patch. DESIGN: Open-label randomized trial. SETTING: Multicenter study. PATIENT(S): A total of 500 healthy, premenopausal, nonpregnant women who had recently used combined oral contraceptives. INTERVENTION(S): Contraceptive ring vs. contraceptive patch. MAIN OUTCOME MEASURE(S): Subjects completed the Female Sexual Function Index (FSFI) before randomization to the study product and after 3 months. Unadjusted and adjusted changes in total and domain FSFI scores from baseline to exit were compared between treatment groups using linear regression (intention-to-treat approach). RESULT(S): Final adjusted mean total FSFI scores increased by 0.32 points in the patch group and decreased by 0.74 points in the ring group. Subjects in the ring group had worsening scores in the areas of arousal (score change -0.169 ring vs 0.010 patch), lubrication (score change -0.202 ring vs. 0.031 patch), and pain (score change -0.162 ring vs. 0.182 patch). CONCLUSION(S): Among recent combined oral contraceptive users, slight decrements in sexual function scores were noted with contraceptive ring use overall and in several domains of sexual functioning, whereas slight increases were noted with patch use. However, for both products, these changes are not likely to be clinically significant.

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Why use of dienogest for the first contraceptive pill with estradiol?

Seeger, Harald (contact); Mueck, Alfred; Bühling, Kai

Abstract: Dienogest (DNG) has the essential properties of an effective progestogen for use in a new contraceptive pill using estradiol valerate as estrogenic component – it inhibits ovulation and protects against endometrial proliferation. DNG is a derivative of norethisterone (NET), but has a cyanomethyl- instead of an ethinyl-group in C17 position which may offer a variety of benefits regarding hepatic effects. The similarity to NET is reflected in the high endometriotropy and in similar pharmacokinetics like short plasma half-live and high bioavailability. However, DNG also elicits properties of progesterone derivatives like neutrality in metabolic and cardiovascular system and considerable antiandrogenic activity, the latter increased by lack of binding to SHBG as speficific property of DNG. It has no glucocorticoid and anti-mineralocorticoid activity and has no antiestrogenic activity with the consequence that possible beneficial estradiol effects should not be antagonized. This may be of special importance for the tolerability and safety of the first pill with estradiol valerate instead of ethinylestradiol, although well-designed post-marketing studies are still ongoing to demonstrate what can be expected on the basis of pharmacology.

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