Combined Hormonal Contraceptives and Progestins
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What is the primary function of combined hormonal contraceptives (CHCs) in the context of endometriosis?

  • Promote ovulation
  • Enhance blood flow to endometrial tissues
  • Induce a state of hypoestrogenism (correct)
  • Increase estrogen production

    • What is suggested about the relationship between CHC use and the development of endometriosis?

  • Endometriosis is only treatable with CHCs
  • CHC use does not increase the likelihood of developing endometriosis (correct)
  • CHC use increases the severity of dysmenorrhea
  • CHC use directly causes endometriosis

    • Which effect is observed from the use of CHCs on the symptoms of endometriosis?

  • Increased inflammation
  • Strengthened retrograde menstruation
  • Decreased prostaglandin production (correct)
  • Elevated dysmenorrhea

    • What was the conclusion of the non-randomized cohort study regarding women using CHCs?

    <p>Risk of endometriosis is low in current CHC users (B)</p> Signup and view all the answers

    What impact do CHCs have on backflow menstruation?

    <p>Reduce retrograde menstruation (A)</p> Signup and view all the answers

    What type of feedback loop do CHCs create to suppress ovarian hormone secretion?

    <p>Negative feedback loop (C)</p> Signup and view all the answers

    How does the use of CHCs affect pelvic oxidative stress?

    <p>Reduces pelvic oxidative stress (D)</p> Signup and view all the answers

    What demographic was analyzed in the cohort study related to CHC use?

    <p>Women who have used CHCs previously (C), Women using CHCs currently (D)</p> Signup and view all the answers

    What was the significant outcome observed with metformin in the treatment of endometriotic implants in rats?

    <p>It reduced the size and number of endometriotic implants. (D)</p> Signup and view all the answers

    Which treatment's effectiveness and tolerability are currently under investigation in a randomized, double-blind phase IIb clinical trial?

    <p>Anastrozole (D)</p> Signup and view all the answers

    What effect did retinoic acid and Elocalcitol have on endometriotic lesions in a mouse model?

    <p>Reduced the size and weight of the lesions. (C)</p> Signup and view all the answers

    What requirement was noted when using certain treatments for endometriosis?

    <p>Concurrent contraception was required. (B)</p> Signup and view all the answers

    What did the administration of resveratrol accomplish in animals prone to endometriosis?

    <p>Reduced the size and number of endometrial lesions. (D)</p> Signup and view all the answers

    What is a notable benefit of LNG-IUS compared to other treatments according to the findings?

    <p>It has no negative effects on lipid metabolism (B)</p> Signup and view all the answers

    Which treatment was found to be less effective than GnRH agonists for alleviating endometriosis pain?

    <p>Placebo (B)</p> Signup and view all the answers

    Which of the following outcomes improved significantly with LNG-IUS insertion?

    <p>Dysmenorrhea relief (B)</p> Signup and view all the answers

    What percentage of users experienced amenorrhea within 12 months when using GnRH agonists?

    <p>20% (A)</p> Signup and view all the answers

    How do GnRH agonists compare to elagolix in terms of effectiveness at three months?

    <p>More effective (C)</p> Signup and view all the answers

    What was one significant benefit noted for the use of LNG-IUS?

    <p>Enhances quality of life (C)</p> Signup and view all the answers

    Which treatment is stated to be as effective as LNG-IUS in pelvic pain alleviation after 6 months?

    <p>GnRH agonists (B)</p> Signup and view all the answers

    What issue does the requirement of daily intake in some treatments lead to?

    <p>Poor patient compliance (C)</p> Signup and view all the answers

    What is one potential risk associated with continuous use of certain hormonal therapies?

    <p>Unpredictable bleeding (C)</p> Signup and view all the answers

    Which option may help increase compliance in patients regarding hormonal treatment?

    <p>Cyclic use (A)</p> Signup and view all the answers

    Which method of hormonal delivery was found to be superior in terms of efficiency and satisfaction?

    <p>Vaginal rings (B)</p> Signup and view all the answers

    What physiological effect do progestins have in endometrial tissues?

    <p>Induce decidualization and atrophy (C)</p> Signup and view all the answers

    Why might individual patient preferences be important in hormonal treatment plans?

    <p>They can determine treatment efficacy (D)</p> Signup and view all the answers

    What is a significant downside of using progestins in endometriosis?

    <p>Reduced progesterone receptor expression (C)</p> Signup and view all the answers

    Which of the following hormonal methods is NOT mentioned as a form of delivery?

    <p>Intravenous infusions (C)</p> Signup and view all the answers

    What effect do progestins have on estrogen-induced mitosis?

    <p>They inhibit it (B)</p> Signup and view all the answers

    What is one of the potential side effects of prolonged therapy with elagolix?

    <p>Loss of libido (D)</p> Signup and view all the answers

    Why is the clinical use of elagolix limited to 6 months?

    <p>Concerns about long-term impact on bone mineral density (BMD) (D)</p> Signup and view all the answers

    Which side effect is associated with both elagolix treatment and hormonal therapies?

    <p>Headaches (B)</p> Signup and view all the answers

    What was the objective of the Elaris EM-I and Elaris EM-II studies?

    <p>To assess the effectiveness of elagolix for dysmenorrhea and pelvic pain (A)</p> Signup and view all the answers

    What significant physical change could occur with prolonged elagolix therapy?

    <p>Significant decrease in bone mineral density (C)</p> Signup and view all the answers

    What dosage of elagolix was found to be effective in the studies mentioned?

    <p>150 mg once daily and 200 mg twice daily (C)</p> Signup and view all the answers

    Which of the following side effects is NOT commonly associated with elagolix treatment?

    <p>Muscle cramps (D)</p> Signup and view all the answers

    Which study was conducted in the United States?

    <p>Elaris EM-I (B)</p> Signup and view all the answers

    Study Notes

    Combined hormonal contraceptives (CHCs)

    • CHCs are often used off-label for endometriosis-associated pain
    • CHCs suppress ovarian hormone secretion, leading to a decrease in estrogen-induced prostaglandin production and inflammation
    • They promote decidualization of eutopic and ectopic endometrial tissues, reducing retrograde menses and pelvic oxidative stress
    • Cyclic use may increase compliance, while continuous may increase unpredictable bleeding and amenorrhea
    • Individual patient preferences should be determined
    • Vaginal rings (VRs) and transdermal patches are alternative methods of hormonal delivery
    • VRs were more efficient, satisfying, and had better compliance than patches, especially with rectovaginal lesions

    Progestins

    • Progestins include DNG, DSG, MPA, LNG, etonogestrel, and CPA but insufficient data exists to determine superiority
    • Progestins induce decidualization and atrophy of eutopic and ectopic endometria
    • They decrease estrogen-induced mitosis, suppress cell proliferation, inhibit inflammatory pathways, and inhibit angiogenesis and neurogenesis
    • Progesterone receptor expression is reduced in endometriotic lesions

    Gonadotropin-releasing hormone (GnRH) agonists

    • They establish amenorrhea in ~20% of users within 12 months
    • Most effective in improving dysmenorrhea, dyspareunia, and CPP scores at 3 months of treatment
    • Superior to placebo and no-treatment in terms of total pelvic pain alleviation at 6 months
    • Comparable to LNG and danazol in treatment
    • Prolonged therapy can induce BMD decrease exceeding 1% per month in early months
    • Clinical use is limited to 6 months due to long-term impacts on BMD
    • Side effects include depression, lipid profile changes, hot flushes, headaches, urogenital atrophy, and loss of libido

    Levonorgestrel-releasing intrauterine system (LNG-IUS)

    • Has benefits such as lack of negative effects on lipid metabolism and BMD loss due to local progesterone delivery
    • Does not require daily intake, thus decreasing fluctuating serum levels and improving patient compliance
    • Alleviates dyspareunia and dysmenorrhea, enhancing quality of life
    • Reduces serum CA-125 levels and DIE nodule size

    Elagollix

    • Two doses (150 mg once daily and 200 mg twice daily) were effective in alleviating dysmenorrhea and non-menstrual pelvic pain
    • Higher dose significantly improved dyspareunia
    • Side effects recorded include hot flushes and changes in BMD and lipid levels
    • No effect on the volume of endometriomas was observed
    • Concomitant contraception required as it did not inhibit ovulation

    Other treatments

    • Metformin reduces the size and number of endometriotic implants in rats through regulation of ovarian steroidogenesis and anti-inflammatory properties
    • Retinoic acid and Elocalcitol reduced the size and weight of endometriotic lesions in mice
    • Resveratrol reduced the size and number of endometrial lesions in endometriosis-prone animals and in vitro models

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    Related Documents

    Medical Treatment of Endometriosis PDF

    Description

    This quiz covers the use of combined hormonal contraceptives (CHCs) and progestins in managing endometriosis-associated pain. It discusses their mechanisms of action, patient compliance, and the effectiveness of different delivery methods. Explore the details of ovarian hormone suppression and impact on endometrial tissues.

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