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Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence

Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as "informative but with important limitations". Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot-medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Drug Class Review: Hormone Therapy for Postmenopausal Women or Women in the Menopausal Transition Stage: Final Report Update # 3 [Internet]

Estrogen was approved as a hormone supplement in the 1940's to treat estrogen withdrawal symptoms in menopausal women. Estrogen production declines in women when ovarian function changes with aging or after surgical removal of the ovaries. This drop in estrogen levels can trigger a vasomotor response resulting in a sensation of flushing and sweating that interferes with function and sleep (hot flashes or flushes). Studies conducted in recent years have identified additional health benefits of postmenopausal estrogen besides symptom management (osteoporosis) as well as potential harms (cardiovascular disease, breast cancer, and cholecystitis). The purpose of this review was to compare the efficacy and adverse effects of different estrogens.

Drug Class Reviews - Oregon Health & Science University.

Version: October 2007
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 12, 2015
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Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5 [Internet]

In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of all deaths each year. Coronary heart disease continues to be the leading cause of mortality and a significant cause of morbidity among North Americans. In 2006, coronary heart disease claimed 607 000 lives, translating into about 1 out of every 5 deaths in the United States. High levels of cholesterol, or hypercholesterolemia, are an important risk factor for coronary heart disease. The 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations. They are first-line agents for patients who require drug therapy to reduce serum low-density lipoprotein cholesterol concentrations. The purpose of this review is to compare the benefits and harms of different statins in adults and children with hypercholesterolemia.

Drug Class Reviews - Oregon Health & Science University.

Version: November 2009
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Nonsurgical management of heavy menstrual bleeding: a systematic review

OBJECTIVE: To compare the effectiveness of nonsurgical abnormal uterine bleeding treatments for bleeding control, quality of life (QOL), pain, sexual health, patient satisfaction, additional treatments needed, and adverse events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on:

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: February 2015
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Systematic Review of Women Veterans Health Research 2004–2008 [Internet]

Women are playing an ever increasing role in the US military, representing about 15% of active military personnel, 17% of reserve and National Guard forces, and 20% of new military recruits. Concurrently, women are one of the fastest growing groups of new users in the Department of Veterans Affairs (VA) Healthcare System, with particularly high rates of utilization among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Of the more than 100,000 OEF/OIF women veterans, over 44% have enrolled in the VA system for health care. Thus, women veterans represent an integral part of the veteran community.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: October 2010

Identification and Management of Familial Hypercholesterolaemia (FH) [Internet]

While the NHS in England and Wales has made spectacular progress in improving the secondary prevention of cardiovascular disease, we now need to work harder to identify those who are at particularly high risk of myocardial infarction.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: August 2008
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Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of breast and gynecologic cancers, including information about specific genes and family cancer syndromes. The summary also contains information about interventions that may influence the risk of developing breast and Psychosocial issues associated with genetic testing are also discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 11, 2017

Ulipristal Acetate (Fibristal) (5 mg Tablets): Treatment of Moderate to Severe Signs and Symptoms of Uterine Fibroids in Adult Women of Reproductive Age Who are Eligible for Surgery. The Duration of Treatment is Limited to Three Months [Internet]

The objective of this systematic review was to evaluate the beneficial and harmful effects of ulipristal acetate 5 mg for the treatment of the signs or symptoms due to uterine fibroids in adult women of reproductive age who are eligible for surgical intervention.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: December 2013
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The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

The study found some evidence linking pelvic vein incompetence with chronic pelvic pain in women, but insufficient to conclude that it causes chronic pelvic pain in women suffering from no other pathology. Embolisation appears to be safe and to provide symptomatic relief for the majority of women.

Health Technology Assessment - NIHR Journals Library.

Version: January 2016
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Ovulation suppression for endometriosis

This review of 23 trials involving 3043 women with endometriosis has shown that there no evidence of benefit with the use of ovulation suppression for women with endometriosis and infertility. Endometriosis is caused by the lining of the uterus (endometrium) spreading to a site outside the uterus. It is associated with subfertility and can cause pain during both sexual intercourse and menstruation. The hormone oestrogen stimulates the growth of endometriosis. For many years, the use of drugs such as danazol to stop ovulation and the production of oestrogen has been standard practice in the treatment of pain and subfertility caused by endometriosis. This works well for pain, but does not appear to improve fertility. In fact, as ovulation and periods are stopped for the time of treatment, fertility may be reduced by this approach.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015
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Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ®): Health Professional Version

Expert-reviewed information summary about factors that may influence the risk of developing ovarian, fallopian tube, and primary peritoneal cancers and about research aimed at the prevention of them.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 7, 2017

Endometrial Cancer Prevention (PDQ®): Health Professional Version

Expert-reviewed information summary about factors that may influence the risk of developing endometrial cancer and about research aimed at the prevention of this disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 27, 2017

Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage

The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. The guideline includes guidance on when senior and/or specialist advice should be sought in order to avoid errors and unnecessary delay.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2012

Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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Breast Cancer Prevention (PDQ®): Health Professional Version

Expert-reviewed information summary about factors that may increase the risk of developing breast cancer and about research aimed at the prevention of this disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 6, 2017

Melanoma: Assessment and Management

Cutaneous melanoma is increasing in incidence in many of the developed countries as this form of cancer occurs predominantly in pale skinned people who expose themselves to intense sunlight, especially when taking holidays in sunny places. The increased work-load for melanoma services resulting from this increase is furthermore complicated by the fact that the individuals with the most rapid rate of increase in incidence are those over the age of 60 and especially men. Male sex and age are two poor prognostic factors for melanoma and therefore the likelihood is that despite efforts to promote primary and secondary melanoma prevention, melanoma mortality is likely to increase rather than decrease. Although the incidence trends described above are of concern, for the first time in very recent years, the advent of therapies targeted to driver mutations (such as inhibitors of BRAF) and of T cell checkpoint inhibitors which both have efficacy in melanoma is in the process of rapidly changing management of this disease. Use of both classes of drugs has been the subject of NICE technology appraisals in recent years and these have been cross referenced in the text.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: July 2015
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