By Carlos Rotellar
A quick, transparent, useful, and funny method of acute renal insufficiency.
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Progestins have also been used at varying doses to achieve an atrophic state by antagonizing estrogen. It is well recognized that agents such as depo-medroxyprogesterone acetate (Depo-Provera) are associated with amenorrhea. Rates as high as 50% have been reported, but only after significant periods of time. Interestingly, not all progestins are associated with such high levels of amenorrhea. Norethindrone enanthate, an injectable progestin widely used outside the United States, had amenorrhea rates at 1 year of only 30%.
Endometrial electrosurgical resection by hysteroscopy in 32 menorrhagic patients: endometrial preparation with a GnRH agonist may have some effect on results. J Gynecol Surg. 1995;11:65–70. Brooks PG. Complication of operative hysteroscopy. In: Bieber EJ, Loffer FD, eds. Gynecologic Resectoscopy. Cambridge, MA: Blackwell Scientific; 1995:270. Brooks PG, Serden SP, Davos I. Hormonal inhibition of the endometrium for resectoscopic endometrial ablation. Am J Obstet Gynecol. 1991;164:1601–1606. Bulletti C, Ziegler D, Setti PL, et al.
Multiple studies have now documented the increased incidence of endometrial hyperplasia in menopausal patients receiving only estrogen and no progesterone. The addition of progesterone to estrogen replacement regimens markedly reduces the subsequent development of endometrial hyperplasia. Pickar et al. evaluated the effect of multiple estrogen and estrogen/progestin doses versus placebo on the endometrium as part of the Women's Health Osteoporosis, Progestin, Estrogen (HOPE) Study. As would be expected, but is reinforced by this large trial, the dose of estrogen as well as length of exposure were key determinants in the hyperplasia rate.