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Currently available and effective contraceptive methods for men are condoms and vasectomy. Because of the shortcomings of these methods, efforts have been made to develop additional forms of male contraception. The most promising approach is hormonal, which requires administration of exogenous testosterone. When administered to a normal male, testosterone functions as a contraceptive by suppressing...
HRT is indicated to manage problems caused when the ovaries stop producing estrogen at the menopause. Cessation of menses occurs naturally when the ovarian follicles are depleted at about 51 years of age, or following surgical removal of the ovaries with or without hysterectomy. The resulting hypogonadal state may cause symptoms and detrimental changes in estrogen target tissues, including the brain,...
There are no contraceptive methods that are contraindicated on the basis of age alone. For a woman of any age, efficacy and compliance are optimized if she is using her own choice of method. Nevertheless, there are special issues that must be taken into account by clinicians advising adolescent or perimenopausal women about contraceptive choices. For adolescents, specific legal and ethical issues...
Over the last 40 years, there have been enormous advances in the field of contraception. In the late 1950s, options were restricted to male and female sterilization, condoms and diaphragms/cervical caps. Now, in the early part of the 21st century, men and women have 13 or more methods to choose from, yet few are aware of this diversity and health professionals often give misinformation about their...
The menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. Follicular granulosa cells produce estradiol and inhibins. An accelerated decline in follicle numbers occurs from about age 38 years, and the major initial change underlying the menopause is a selective, gradual decline in inhibin B, the major regulator of follicular phase follicle-stimulating...
This contribution considers links between different methods of contraception and the risk of acquiring sexually transmitted infections (STIs). This is a major public health issue, because STIs cause a huge disease burden that affects women disproportionately. Worldwide each year, there are 340 million new cases of curable STIs in 15–49-year-olds. In developing countries, STIs, even excluding HIV,...
Publicity after publication of the Women’s Health Initiative and the Million Women Study has led to women stopping HRT. They may then be troubled with vasomotor symptoms or dyspareunia, and concerned about skeletal conservation. Use of standard pharmacopoeia and alternative and complementary therapies are discussed. Options for treating vasomotor symptoms include progestogens, selective serotonin...
Combined oral contraception is now available as oral, transdermal, vaginal and injectable preparations. Only the pill and patch are currently marketed in the UK. Most of the data come from the oral preparation (the combined pill), which has been marketed for more than 40 years and used by millions of women. Used perfectly, combined hormonal contraception is highly effective (failure rate 1/1000),...
Non-hormonal methods of contraception cover a range of methods from permanent sterilization, requiring an invasive surgical procedure, to natural family planning, which relies on women’s own fertility awareness, and is often taught by non-clinical volunteers. Sterilization and IUDs are the most popular methods worldwide, with 200 million and 100 million users respectively. Sterilization is intended...
Modern methods of contraception are associated with health benefits beyond pregnancy prevention. For some women, these additional benefits influence method choice and continuation rates. Worldwide, the prevention of STIs by male and, to a lesser extent, female barrier methods is the most important non-contraceptive benefit. For individual women, the effect of a number of hormonal contraceptives on...
Eestrogen is a highly effective treatment for menopausal symptoms. Although recent clinical trials do not support use of HRT for long-term protection against chronic disease, many women with unpleasant vasomotor symptoms elect to take HRT for symptom relief. Women who still have a uterus should be prescribed estrogen in combination with some form of progestogen. There are various delivery systems...
Type 2 diabetes is the most common clinical form of diabetes, accounting for about 90% of all cases. It is currently undergoing a worldwide epidemic; the prevalence has tripled during the last 30 years. The most recent surveys in Europe indicate a prevalence of 6% in the middle-aged and older population. In the USA, the prevalence is about 8%. The disease typically affects adults over the age of 40...
Failure of the thyroid gland requires thyroid hormone replacement therapy, which is relatively easily adjusted to replicate the normal physiological state by monitoring plasma levels of thyroxine and/or thyroid-stimulating hormone. In contrast, failure of pancreatic b-cells requires insulin therapy, and optimal replacement requires monitoring, not of the absent hormone (insulin), but of its major...
Diabetes presents several special problems during surgery. The fundamental principle of surgical management in diabetes is that capillary blood glucose is measured regularly and accurately, and that these results are recorded and acted on. Most problems occur because staff have forgotten to measure blood glucose, or because very low values have been ignored or wrongly attributed to faulty meters....
Hypertension is defined as blood pressure 140/90 mm Hg or more. All patients with diabetes should have their blood pressure measured at least annually. Target blood pressure is less than 130/80 mm Hg (lower targets may be appropriate in patients with established renal disease). Angiotensin-converting enzyme inhibitors are the first-line option in most patients. Thiazides may be a reasonable choice...
Type 1 diabetes is caused by autoimmune destruction of pancreatic beta-cells resulting in insulin deficiency, consequent hyperglycaemia and a tendency to develop ketoacidosis. The autoimmune aetiology is supported by the presence of autoantibodies specific for pancreatic antigens in the serum of patients with the condition, infiltration of islets with T cells and macrophages (‘insulitis’) and a strong...
Diabetes is a chronic disorder of glucose metabolism, associated with microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (angiopathy with increased risk of ischaemic heart disease and stroke) complications, as well as premature mortality. There are two main aetiological types of diabetes. Type 1 diabetes classically occurs in children and young adults, and is related to an absolute...
Diabetes is a largely self-managed disease. Consequently, if the patient is unwilling or unable to self-manage his or her diabetes on a day-to-day basis, outcomes will be poor, regardless of how advanced the treatment technology is. Cognitive, emotional, behavioural and social factors have a vital role in diabetes management. More so, as co-morbid depression and other psychological problems are prevalent...
Diabetes mellitus is not a single disorder. It represents a series of metabolic conditions associated with hyperglycaemia and caused by defects in insulin secretion and/or insulin action. Exposure to chronic hyperglycaemia may result in microvascular complications in the retina, kidney or peripheral nerves. Although these are characteristic of diabetes, they cannot be used to define the disorder because...
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