OB-GYN-L Messages for September, 2006: Re: Gyn: Amenorrhea

Re: Gyn: Amenorrhea

From:

Terrence.Jones@kp.org

Thu Sep 28 17:55:48 2006

Jane, there is a great Review by Jeff Jensen (Oregon) in last September's Survey (60:604-12). He cites the original work on comparative plasma levels with oral LNG (Nilson: F&S (1986), 45:805-7, and Contraception (1978), 17:9-17). The CDC review (Kahn, Diabetes Care (2003) demonstrates the increase in abnml GTT and Insulin resistance in DMPA (and Norplant). This was not evidenced with Mirena, in a study from Moscow (coauthor Dr. Grimes), even early after insertion, when serum levels are higher (Rogovskaya O/G (2005), 105:811-5). Nor was there any weight increase compared to copper IUD users in the Brazilian study (Yela Rev Assoc Med Bras(2006), 52:32-6). Yet the local effects on the endometrium (in patients with hyperplasia), were superior to oral progestin (Vereide Gynecol Oncol (2003), 91:526-33). There was a slight increase over baseline on FBS ("FPG" = fasting plasma glucose) in a study from Turkey (Kayikcioglu Contraception(2006), 73:528-31), but not to abnml levels. /tj

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jane@helwig.net (Jane Helwig, MD ) Sent by: ob-gyn-l@obgyn.net 09/28/2006 12:40 Please respond to ob-gyn-l

To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: Re: Gyn: Amenorrhea

TJ, where is the data about lower systemic progestin levels with Mirena? (I have a patient with Type I DM and CF and primary dysmenorrhea who recently had a DVT.) Thanks.

-- Jane Helwig, MD, FACOG Private practice, 2 MDs Lancaster, SC

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Jane, there is a great Review by Jeff Jensen (Oregon) in last September's Survey (60:604-12). He cites the original work on comparative plasma levels with oral LNG (Nilson:  F&S (1986), 45:805-7, and Contraception (1978), 17:9-17). The CDC review (Kahn, Diabetes Care (2003) demonstrates the increase in abnml GTT and Insulin resistance in DMPA (and Norplant). This was not evidenced with Mirena, in a study from Moscow (coauthor Dr. Grimes), even early after insertion, when serum levels are higher (Rogovskaya O/G (2005), 105:811-5). Nor was there any weight increase compared to copper IUD users in the Brazilian study (Yela  Rev Assoc Med Bras(2006), 52:32-6). Yet the local effects on the endometrium (in patients with hyperplasia), were superior to oral progestin (Vereide Gynecol Oncol (2003), 91:526-33). There was a slight increase over baseline on FBS ("FPG" = fasting plasma glucose) in a st! udy from Turkey (Kayikcioglu Contraception(2006), 73:528-31), but not to abnml levels. /tj   NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you. <table width0%> <tr valign=top> <td> <td>jane@helwig.net (Jane Helwig, MD ) Sent by: ob-gyn-l@obgyn.net 09/28/2006 12:40 Please respond to ob-gyn-l <td>                To:        Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>         cc:                 Subject:        Re: Gyn:  Amenorrhea</table> TJ, where is the data about lower systemic progestin levels with Mirena? (I have a patient with Type I DM and CF and primary dysmenorrhea who recently had a DVT.) Thanks. -- Jane Helwig, MD, FACOG Private practice, 2 MDs Lancaster, SC

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