Concentration Changes of Medroxyprogesterone Acetate in Serum and Milk in Lactating Woman Who Used Depo Geston~

Objective To determine the concentration changes of medroxyprogesterone acetate （MPA） in serum and milk in the Chinese lactating women who used Depo Geston Methods Ten postpartum and breastfeeding women received an injectable contraceptive of Depo Geston （depo medroxyprogesterone acetate, DMPA, 150 mg/ampoule）. Serum and milk samples were collected in the 1^st, 2^st, 4^th, 6^th, 8^th 10^th and 12^th week after contraceptive injection. The concentrations of medroxyprogesterone acetate （MPA） in serum and milk were determined by radioimmunoassay. Results The highest MPA concentration in serum was observed at the 1^st week and then the level of serum MPA decreased obviously at the 2^na and 4^th week. After the 4^th week, the decline of serum MPA level slowed down. The concentration of milk MPA reached the highest level at 1^th week. But at the 2^nd week the average level of MPA in milk dropped by half The MPA concentration in the milk was changed in the range of 5.2-8.3 ng/mL in the following 10 weeks. During observation, the average ratios of concentration and area under curve （AUC） in milk/serum were both 0.55. There was a wide variation in MPA concentrations and ratios of milk/serum between subjects. Conclusion MPA concentrations maintained a certaim level at the 12^th week after DMPA injection. However, whether mather＇s intake of DMPA during feeding period has effect on children＇s growth, espcially pubertal growth, deserves further studies.

Effect of Depot Medroxyprogesterone Acetate (DMPA) on Bone Mineral Density in Women of Reproductive Age

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate（DMPA ） and nonhormonal control subjects. Methods The study included 68 women aged between 25 and 40 years using depot medroxyprogesterone acetate for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results At 24 months of treatment, as compared with baseline, the mean BMD in lumbar spine and femoral neck was decreased by 5.5% and 5.9%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA were significantly decreased compared with the subjects in nonuser （P〈0.001）. Conclusion These results show BMD declined during using DMPA in women aged 25 -40 years old.

Clomiphene Citrate or Medroxyprogesterone Acetate with Human Menopausal Gonadotropin in Poor Responders during In vitro Fertilization/Intracytoplasmic Sperm Injection Treatments Combined with Embryo Cryopreservation?

Objective:This study aimed to compare the efficacy of clomiphene citrate(CC)with human menopausal gonadotropin(hMG)and that of medroxyprogesterone acetate(MPA)with hMG in poor responders defined according to the Bologna criteria.Methods:The data of patients with poor ovarian response(POR)according to the Bologna criteria from September 2016 to November 2017 were retrospectively reviewed.All participants received either CC+hMG or the progesterone-primed ovarian stimulation protocol(PPOS)protocol.Results:A total of 340 patients and 563 in vitro fertilization cycles were analyzed in this study.The incidence of spontaneous luteinizing hormone(LH)surge and the mean LH level on trigger day were significantly lower in the PPOS group than in the CC+HMG group(0.04%vs.3.49%and 4.26±3.59 vs.9.38±6.92 mIU/mL,respectively,P<0.05);however,the incidence of premature ovulation was similar between the two groups.The number of viable embryos harvested was not statistically different between the two groups(1.7±1.1 vs.1.5±0.8,P=0.06).The mean dose and duration of hMG were significantly higher in the PPOS group than in the CC+hMG group(908.7±556.6 vs.177.9±214.5 IU and 6.0±3.4 vs.1.2±1.5 days,respectively,P<0.05).However,the number of oocytes retrieved,number of metaphase II oocytes,and fertilization rate were comparable between the two groups.Conclusions:The CC with low-dose gonadotropin strategy was superior to the MPA with hMG protocol for POR.

Effect of depot medroxyprogesterone acetate on bone mineral density in adolescent women

Background Depot medroxyprogesterone acetate （DMPA） as a hormonal contraceptive is highly effective and widely used, but it may reduce bone mineral density （BMD） and increase the risk of osteoporosis. We compared BMD between users of intramuscular DMPA and nonhormonal subjects. Methods The study included 102 women aged between 16 and 18 years using DMPA for 24 months and 97 women aged between 16 and 18 years using nonhormonal contraception as nonusers control group. BMD of the lumbar spine and femoral neck was measured every 12 months for 24 months using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA users and nonusers.

Effect of depot medroxyprogesterone acetate(DMPA) on bone mineral density(BMD) and evaluating changes in BMD after discontinuation of DMPA in adolescent women

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate （DMPA） and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA.Methods The study included 102 women aged 16-18 years using DMPA for 24 months and 97 same-age nonusers. BMD of the lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry. The mean BMD values were compared between DMPA users （DMPA group） and nonusers （control group） and the changes of BMD during 36 months after discontinuation of DMPA were observed.Results Mean BMD at the spine and femoral neck did not differ significantly between DMPA group and control group over 12 months, but the BMD values at both anatomical sites were significantly lower in DMPA group than in control group after 24 months treatment. After DMPA discontinuation, the mean BMD values in DMPA users increased substantially. At 24 months after DMPA discontinuation, there were no significant differences between DMPA group and control group. But the values of the lumbar spine and femoral neck BMD in DMPA group were still 1.70% and 1.87%, respectively, below nonusers at 36 months after DMPA discontinuation.Conclusion The use of DMPA for short-term （ ≤12 months） had no significant effects on BMD at spine and femoral neck, but long-term exposure to DMPA had significant loss in BMD in adolescents. Bone loss occurring with DMPA use is reversible after DMPA discontinuation.

Changes in bone mineral density among women aged 19-24 years using injectable contraceptive depot medroxyprogesterone acetate

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate （DMPA） and nonhormonal control subjects. Methods The study included 87 women aged between 19 and 24 years using DMPA （DMPA group）for 24 months and 83 same-age women using nonhormonal contraception as control group. BMD of the lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA group with the control. Results After 24 months of DMPA treatment, as compared ~ith baseline, the mean BMD in lumbar spine and femoral neck were decreased by 2.67% and 2.71%, respectively. The mean lumbar spine and femoral neck BMD in DMPA group at 24 months were not significantly different compared with baseline （P=0. 080 and P=0. 076, respectively）. In comparison, in control group, there was a trend toward increasing BMD. After 24 months of observation, the mean percentage changes from baseline in lumbar spine and femoral neck BMD were increased by 1.24% and 1.30%, respectively. There was no significantly difference compared with baseline （P=0. 436 and P=0.373, respectively）. Mean BMD at the spine and femoral neck did not differ significantly between DMPA users and nonusers over 12 months （P=0.153 and P=0.140, respectively）, but the BMD at both anatomical sites was significantly lower in DMPA group than in the control after 24 months of treatment （P=0.012 and P=0.008, respectively）. Conclusion The use of DMPA for short-term （≤12-month） had no significant effects on BMD at spine and femoral neck, but long-term exposure to DMPA had significant loss in BMD in women aged between 19 and 24 years.

The Expression of Cyclooxygenase-2 in Cervical Cancers and Hela Cells Was Regulated by Estrogen/Progestogen

To investigate the relationship between the expression of cyclooxygenase-2 （COX-2） and menstrual cycle, the regulatory effects of 17-β-estradiol （E2） and medroxyprogesterone acetate （MPA） on the expression of COX-2 in cervical cancer Hela cells were examined. Cervical cancer specimens were obtained from 47 pre-menopausal patients. The phase of menstrual cycle was determined by case history and HE staining of uterine endometrium. COX-2 was immunohistochemically stained by SABC staining and the staining intensity was determined with computerized image analysis system. Hela cells were incubated with alcohol, E2, E2＋MPA, MPA for 12, 24 and 48 h respectively. The expression of COX-2 in Hela cells was detected by Western blotting and reverse transcriptase-polymerase chain reaction （RT-PCR）. Our results showed that the expression of COX-2 was significantly higher during proliferative phase than secretory phase （P〈0.05）, but there was no difference in the positive rate between proliferative phase and secretory phase （P〉0.05）. Incubation with E2 could significantly enhance the expression of COX-2 continually. On the contrary, E2＋MPA and MPA alone could decrease the expression of COX-2 as compared with the control and E2 group （P〈0.05 and P〈0.01 respectively）. It is concluded that the expression of COX-2 in cervical cancer of pre-menopausal patients and Hela cells was regulated by estrogen/progestogen.

The Use of Hormonal Contraceptives and Preeclampsia among Ghanaian Pregnant Women

Hormonal contraceptives (HC) are thought to play a role in the pathogenesis of cardiovascular diseases. The study evaluated the use of HC as a primary cause of preeclampsia (PE) among Ghanaians. This study comprised 30 preeclamptic women and 30 healthy normotensive pregnant women with over 20 weeks of gestation at the Comboni Hospital, Ghana using a randomized case-control study. Blood pressure, weight, height, socio-demographics, medical and previous obstetric history were taken and recorded. Blood samples were collected for the estimation of homocysteine and fasting lipids. Estimated foetal weight (EFW) and infant birthweight (BWT) were obtained from maternal records. This study was carried out in 2019. 80.0% of women with PE used the hormonal contraceptive “depot medroxyprogesterone acetate” (DMPA) prior to pregnancy. The use of DMPA was associated with about thirty-fold increase in the odds of developing PE (OR = 29.71, p < 0.001). Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), triglycerides (P = 0.024), LDL-C (P = 0.026), and homocysteine levels (P < 0.001) were significantly elevated in the PE cases than the normal pregnant (NP) women, whilst EFW (P < 0.001), BWT (P < 0.001) and HDL-C levels (P = 0.001) were significantly reduced in the PE cases when compared to NP women. 50% and 47% of PE cases had intrauterine growth restriction and low birthweight infants, respectively. In conclusion, DMPA use predisposes women to a high risk of developing PE. DMPA could partly contribute to endothelial dysfunction, hyperhomocysteinaemia, dyslipidaemia and excessive weight gain, all of which characterize PE.

A comparison of two different dosages of conjugated equine estrogen in continuous combined hormone replacement therapy with progestin

To investigate the effects of two different dosages of conjugated equine estrogen (CEE) on preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause Methods A total of 236 postmenopausal women were randomly allocated to one of the following groups: Group A: 0 625 mg CEE+2 mg medroxyprogesterone acetate (MPA)+1 tab Caltrate-D per day; Group B: 0 3 mg CEE+2 mg MPA+1 tab Caltrate-D per day; Group C: 1 tab Caltrate-D per day as the control group The study was continued for 2 years The following parameters were monitored: ① L2-4 bone mineral density (BMD) (measured with dual energy X-ray absorptiometry (DEX)), ② menopausal syndr ome improvement (assessed by comparing Kupperman scores), ③ vaginal bleeding rate, and the thickness of the endometrium and breast in each group Results Overall, 213 cases (90%) completed the 1-year study and 176 cases (75%) completed the 2-year study The percentage changes in L2-4 BMD at the 12th and 24th month in Group A were +2 3% and +3 7%, respectively, with the posttreatment values being significantly higher than pretreatment values (P<0 001) The percentage changes were +2 7% at 12th month (P<0 05) and +0 7% at 24th month (P>0 05) in Group B And that of Group C were -0 4% at 12t h month and -1 6% at 24th month (P>0 05) L2-4 BMD in both Group A and B w as significantly higher than that in Group C at 12th and 24th month (A vs C, P<0 001; B vs C, P<0 05) Kupperman Sco res were significantly reduced after 1, 3, 6 ,12 and 24 months in all 3 groups when compared with baseline (P<0 001) Scores in Group A and Group B were significantly lower than that in Group C (P<0 001) However, the vaginal bleeding rates in Group A were significantly higher than that in Group B or in Group C There was no atypical hyperplasia of endometrium in the 3 groups by the end of the study One p atient in Group A developed superficial thrombophlebitis by the end of 12th month Conclusion Continuous combination of CEE and MPA is effective in preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause The vaginal bleeding rates in the Group treated with 0 625 mg/d CEE were significantly higher than those treated with 0 3 mg/d CEE