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Bone mineral density at femoral neck: z -score during treatment. Medians are connected. Boxes represent 25 and 75 percentiles, whiskers 5 and 95 percentiles.
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An open, prospective, comparative study was done in healthy women, aged between 18 and 40 years, to study the effects of long-term
etonogestrel treatment on bone mineral density (BMD). The control group used a non-hormone-medicated intrauterine device (IUD).
The BMD was measured using a dual energy X-ray absorptiometry instrument. Measurements incl...
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Citations
... R. Beerthuizen и соавт. (2000 г.) [25] провели открытое проспективное сравнительное исследование с участием здоровых женщин (n=44) в возрасте от 18 до 40 лет для изучения влияния длительного применения имплантата с этоногестрелом на минеральную плотность костей (МПК). Контрольная группа (n=29) использовала ВМС, не содержащую гормонов. ...
... Результаты исследования R. Beerthuizen и соавт. показывают, что Импланон можно безопасно использовать в том числе у молодых женщин, которые еще даже не достигли своей пиковой костной массы [25]. P. Hadji и соавт. ...
This review presents information on demographic processes in Russia and the relevance of highly effective contraception for the prevention of artificial abortion. We present data on the etonogestrel implant (68 mg), an innovative single-stranded subcutaneous implant, a long-acting reversible contraceptive option with high efficacy (Pearl index 0.05) with optimal and typical use of the product. We analyzed the results of the studies that showed a favorable safety profile of the etonogestrel implant with no significant effect on the risks of thrombotic events, metabolic processes, depression incidence, bone mineral density, and characteristics of reproductive function after discontinuation of the drug. The article presents data on possible side effects in the form of changes in the characteristics of menstrual bleeding and a slight increase in body weight, which is comparable with the natural gain in an adult with age. The importance of qualified counseling of patients before and during the use of etonogestrel implants is emphasized.
... 9 No effect has been observed on bone mineral density. 10,11 Implementation ...
... The usage of the ENG-releasing method, like DMPA, has been linked to BMD loss. The data, however, is mixed, with studies finding both steady [105] and decreased BMD [106]. Furthermore, implant migration has been a source of worry, despite the fact that it is expected to occur at a rate of 1.3 per million implanted devices [73]. ...
Contraception has previously provided alternative medication delivery techniques for the treatment of endometriosis. Only LNG-IUSs and depot formulation (DMPA), however, have been studied in numerous RCTs to treat patients. These approaches tend to enhance patient compliance and satisfaction when compared to other conventional treatment alternatives. Nanotechnologies are potential new drug delivery techniques that have been shown to deliver compounds with a particular therapeutic impact. However, the information is limited and preliminary. Endometriosis research has identified the patients who could benefit most from this kind of medication administration. No one has ever been used in a clinical study to treat endometria. Alternative medication delivery techniques may help to enhance compliance, effectiveness, and the development of novel treatment approaches. The use of vaginal rings as a unique and alternative medication delivery route for AIs, as well as the experience with danazol, are examples. The vaginal ring has been studied as a new medication delivery mechanism for danazol and aromatase inhibitors. Nanotechnologies are made up of bioconjugates that deliver anti-inflammatory, antioxidant, anti-angiogenic, and immunomodulating chemicals directly to the illness site. At this early stage of proof-of-concept, the evidence is limited and tentative. Clinical effectiveness can not be predicted using mouse models.
... Similar to DMPA, the use of the ENG-releasing system has been associated with BMD loss. However, the evidence is conflicting with studies reporting both stable [105] and reduced BMD [106]. Moreover, some concerns have been raised regarding implant migration, although it is estimated to have a frequency of 1.3/every million inserted devices [73]. ...
Introduction:
Pharmacotherapy has a key role in the management of endometriosis. However, a significant proportion of patients gains only intermittent or limited benefits. In this regard, alternative and novel drug delivery methods are of paramount importance to improve efficacy and compliance of available treatments and develop alternative medical approaches.
Areas covered:
This review aims to provide the reader with a complete overview of available evidence about alternative and novel drug delivery methods for endometriosis pharmacotherapy and highlight new research lines.
Expert opinion:
Progestins and estroprogestins, which represent the first-line therapy, are already available in different formulations, being employed for contraception. Nevertheless, evidence on their adoption is still limited for some drug delivery methods, such as vaginal rings, patches, and subcutaneous implants. Further research is needed to define better their clinical utility in patients with endometriosis. Nanotechnologies have been investigated as novel drug delivery methods able to target the drug at the disease level. However, data are very limited and preliminary, and further research is needed to consider a possible clinical application in endometriosis.
... However, other implant studies could not support these findings (Safarti et al., Modesto et al., Pettiti et al. [29,30,31]). Beerthuizen et al. [32] could show that the use of the longterm progestogen implant Implanon (= 68 mg etonogestrel) for 3 years was not associated with a decrease of the BMD. The estradiol levels at the end of the study were 110 pg/ml in the Implanon group and 85 in the control group with no differences between both groups regarding bone mineral density. ...
Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2 processes that may predispose to fragility fractures in later life. The relative importance of bone acquisition during growth versus bone loss during adulthood for fracture risk has been explored by examining the variability of areal bone mineral density (BMD) (aBMD) values in relation to age. Bone mass acquired at the end of the growth period appears to be more important than bone loss occurring during adult life. The major physiological effect of estrogen is the inhibition of bone resorption. When estrogen transcription possesses binds to the receptors, various genes are activated, and a variety modified. Interleukin 6 (IL-6) stimulates bone resorption, and estrogen blocks osteoblast synthesis of IL-6. Estrogen may also antagonize the IL-6 receptors. Additionally, estrogen inhibits bone resorption by inducing small but cumulative changes in multiple estrogen-dependent regulatory factors including TNF-α and the OPG/RANKL/RANK system. Review on existing data including information about new estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen receptors than the C21 progestins. This article reviews the effect of estrogens and progestogens on bone and presents new data of the currently approved drospirenone-only pill. The use of progestin-only contraceptives leading to an estradiol level between 30 and 50 pg/ml does not seem to lead to an accelerate bone loss.
... pg/ml 7 and 10 years, respectively, after device placement [29]. With regard to the ENG implant, the E 2 values are also below normal values [30]. ...
... However, the two progestin-only contraceptives tested act differently because the ENG implant is associated with anovulation for a period of 3 years and the 52-mg LNG-IUS is only associated with anovulation during the initial months after placement. Nevertheless, despite the differences in ovulation patterns the contraceptives do not present differences in E 2 levels, which is the most important outcome in women with endometriosis [28][29][30]. ...
Objectives: The aims of the study were to correlate endometriosis-associated pain, evaluated by visual analogue scale (VAS) scores, with serum levels of etonogestrel (ENG), levonorgestrel (LNG), CA-125 and soluble CD23 in users of the ENG implant or the 52-mg LNG-releasing intrauterine system (52 mg LNG-IUS) for up to 2 years after device placement.
Methods: A randomised trial was conducted at the University of Campinas Medical School, Brazil. All participants (n = 103) had had endometriosis-associated chronic pelvic pain or dysmenorrhoea, or both, for more than 6 months. Participants were randomly assigned to use an ENG implant (experimental treatment) or a 52-mg LNG-IUS (active comparator). Follow-up was conducted 6 monthly for up to 24 months after device placement. Dysmenorrhoea and chronic pelvic pain were evaluated using a VAS and the scores were correlated with serum levels of ENG, LNG, CA-125 and soluble CD23.
Results: Both progestin-only contraceptives significantly reduced VAS scores for dysmenorrhoea and chronic pelvic pain and reduced serum levels of soluble CD23 (p < 0.001). Serum levels of CA-125 decreased only in the ENG implant group after 24 months’ use of the device (p < 0.001). No correlation was found between pain scores and ENG or LNG serum levels over time (p > 0.005).
Conclusion: Both contraceptives improved dysmenorrhoea and chronic pelvic pain scores in women with endometriosis-associated pain and they reduced serum levels of soluble CD23; however, serum levels of CA-125 were reduced only in ENG implant users over the 24-month study period.
... 11,12 In implant users, 1.9kg weight gain has been documented over 2 years. 13 Complications while insertion include pain, bleeding, hematoma, difficulty in insertion and implant retention in the needle of the applicator. 8,14 Pain at the implant site is the most common complaint (29% at any visit, 0.5% at last visit). ...
Objectives: To determine the frequency of complications and side effects of single rod etonogestrel implant (implanon). Study Design: Descriptive case series. Setting: At Contraceptive clinic, (Reproductive Health Clinic (Contraception), antenatal clinic of the Department of Obstetrics & Gynaecology, Nishtar Hospital Multan. Period: From November 2014 to November 2016. Material & Methods: The sample included 72 healthy active women. The final outcome in this study was efficacy. Results: Client mean age was 28.07±4.88 years. Usually clients 57 (79.2%) were 1-4 para. 5 (6.9%) clients complain of pain, out of which only 4 had pain at insertion site and 1 had pain at insertion site and also in stomach. No side effects were observed 55 clients (67.4%) main complains about menstrual disturbance like 26 (36.1%) having amenorrhea. Continuous bleeding was the main complain in 9 clients (12.5%), heavy menstruation was found in 7 (9.7%), 10 (13.9%) had irregular bleeding. Prolonged bleeding was present in 2 clients (2.8%), 7 (9.7%) complain of spotting, 10 (13.9%) had no menstruation problem. Conclusion: The results of this study showed that majority of the clients had amenorrhea.
... pg/ml 7 and 10 years, respectively, after device placement [29]. With regard to the ENG implant, the E 2 values are also below normal values [30]. ...
... However, the two progestin-only contraceptives tested act differently because the ENG implant is associated with anovulation for a period of 3 years and the 52-mg LNG-IUS is only associated with anovulation during the initial months after placement. Nevertheless, despite the differences in ovulation patterns the contraceptives do not present differences in E 2 levels, which is the most important outcome in women with endometriosis [28][29][30]. ...
Objective: The aim of the study was to assess the serum levels of the following biomarkers in women with endometriosis-associated pelvic pain before and after six months of using the etonogestrel (ENG) contraceptive implant or the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS): cancer antigen (CA)-125, cluster of differentiation (CD) 23 and endometrial nerve fibre density.
Methods: The study was conducted at the Department of Obstetrics and Gynaecology, University of Campinas Medical School, Brazil. A total of 103 women with endometriosis-associated pain diagnosed by surgery, transvaginal ultrasound and/or magnetic resonance imaging were included. Endometrial nerve fibre density and serum levels of CA-125 and soluble CD23 were assessed before and after six months of using the allocated method and were correlated to 10 cm visual analogue scale (VAS) scores for non-cyclical pelvic pain and dysmenorrhoea.
Results: Both contraceptive methods significantly reduced concentrations of serum soluble CD23 and endometrial nerve fibre density (p < .001); however, CA-125 was significantly reduced only among users of the ENG implant (p < .05). No correlation was observed between reduction of biomarkers and improvement of VAS pain and dysmenorrhoea scores. No differences were observed between the ENG implant and the LNG-IUS.
Conclusion: Both progestin-only contraceptives significantly reduced two out of the three biomarkers evaluated. These two biomarkers could, therefore, be used as surrogate markers to follow up medical treatment of endometriosis-associated pain.
... As such Etonogestrel should be considered as an alternative in treating endometriosis associated pain. Etonogestrel should be preferred to DMPA because it has not shown to have any effect on BMD [58] and also in patients with a high body mass index (BMI) and in women with a desire for pregnancy. There has been no recent clinical study assessing Etonogestrel for endometriosis. ...
Endometriosis is a benign, chronic inflammatory condition characterized by the presence and growth of endometrial implants outside the uterine cavity. The cause of endometriosis is multifactorial. It is due to the diversity of hypothesis and plausibility of hormonal alterations which could play a major role. Evidence has shown that progesterone resistance is a key factor for endometriosis sufferers. Medical therapy can avoid surgical intervention, which may lead to a reduced in ovarian reserve, and its effects of earlier menopause and reduced fecundity. Progesterone receptor isoform has provided new insight as the potential treatment. Progestin, anti-progestin and selective progesterone receptor modulators usage, which target these receptors, could avoid hypo-estrogenic side effects, which can be debilitating. Numerous types of these medications have been used on and off labeled to treat endometriosis with varying success. This review aims to consolidate series of clinical trials using progestins in endometriosis.
... cause of interruption in the latter group was unbearable bleeding irregularities (n = 2). The effect of ENG-implant on BMD has been evaluated in a prospective comparative study in 2000 [98]. The effect of ENGimplant on BMD was compared to a nonhormone-medicated IUS. ...
Introduction:
Endometriosis is an estrogen-dependent chronic inflammatory disorder that requires a life-long management plan. Long-term adherence to treatment is pivotal to ensure an effective clinical management. In this optic, one of the cornerstone of endometriosis medical treatment is represented by progestins. Areas covered: This narrative review examines the clinical efficacy, safety and tolerability of oral and depot progestins used in the treatment of endometriosis. The material included in the current manuscript was obtained with a MEDLINE search through PubMed from inception until January 2017. Expert opinion: Progestins are effective in controlling pain symptoms in the majority of women with endometriosis, and their effect seems not inferior to that achieved with other compounds used to treat the disease, such as gonadotropin-releasing hormone agonist. Available progestins include a broad range of both oral and depot compounds, and represent, in most cases, an inexpensive treatment option. In addition, progestins do not increase significantly thrombotic risk and could be adopted in those women with metabolic or cardiovascular contraindication to estrogen-progestins. The choice between the different available compounds should be tailored for every woman with preference to the most cost-effective treatment, depending on the most complained symptom and disease location.
