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  • Title: Therapeutic uses of contraceptive steroids.
    Author: Starks GC.
    Journal: J Fam Pract; 1984 Sep; 19(3):315-21. PubMed ID: 6470632.
    Abstract:
    During the past 20 years, contraceptive steroids have undergone significant changes as the result of an increased understanding of their metabolic, pharmacologic, and hormonal activities. During this time, prospective and retrospective epidemiologic studies have elucidated several noncontraceptive health benefits of oral contraceptive steroids, including their therapeutic effects for endometriosis, dysmenorrhea, polycystic ovarian disease, and benign breast disease. From this review it appears that the benefits of oral contraceptive steroids in young, healthy, nonsmoking women far outweigh their more publicized, infrequent risks. This paper reviews the therapeutic effects of orsl ontraceptive steroids in the treatment of endometriosis, dysmenorrhea, polycystic ovarian disease, and benign breast disease. During the past 20 years, understanding of the metabolic, hormonal, and pharmacological activities of contraceptive steroids has increased. A refinement of dosage combinations and the introduction of biphasic and triphasic preparations have increased the versatility and therapeutic applications of contraceptive steroids. Their major mode of action is exerted at the hypothalamic-pituitary-ovarian and uterine sites, making them suitable for the treatment of abnormal states related to these areas. Use of contraceptive steroids in the treatment of endometriosis produces symptomatic relief in 47-83% and fertility restoration in 40-72%, with a clinical recurrence rate of 11-35%. The prefered regimen in patients not immediately desirous of pregnancy is chronic suppression for 6-9 months with a low-dose contraceptive agent, followed by cyclic therapy. Contraceptive steroids produce symptomatic relief in 90% of women with primary dysmenorrhea and have the added benefits of less bleeding and fewer pregnancies. In cases of hirsutism, a 50% reduction of androstenedione and testosterone is achieved at the end of 4-6 weeks of therapy. Oral contraceptive steroids also suppress gonadotropin secretion, decrease stromal androgens, and prevent endometrial hyperplasia or neoplasia through a progestin-dominated estrogen progestin substitution in polycystic ovarian disease. An estrogen-progestin combination is recommended for the management of dysfunctional uterine bleeding. Contraceptive steriods have also been effective in the treatment of benign breast conditions such as cyclic breast pain and nodularity. Finally, contraceptive steroids have been used as the 1st line of medical therapy in women under 35 years of age with functional ovarian cysts. This review suggests that the benefits of contraceptive steroids in young, healthy, nonsmoking women far outweigh their more publicized, infrequent risks.
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