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T Luukkainen

Publications and source records attributed to T Luukkainen.

At least 19 recordsLinked to original sources
PubMed2003

Issues to debate on the Women's Health Initiative: failure of estrogen plus progestin therapy for prevention of breast cancer risk.

Several studies on hormone replacement therapy (HRT) in the USA have been published. They revealed that the risk of breast cancer is increased with HRT more than with estrogen alone (ERT). A progestin has been given with each dose of ERT, as was the case in the Women's Health Initiative (WHI) study. The results of studies in Europe show similar trends. The increased risk of breast cancer in the WHI study was significantly higher only in women who had used HRT for several years before entering the study. The study was non-blind in 3444 cases, i.e. 40.5% of women in the estrogen plus progestin group and 6.8% in controls. If the women in the HRT group had more mammographic examinations it could change the validity of the results of the study. Estradiol-containing drugs have now been added to the list of carcinogens and the packages of these drugs have warning labels. The results of the WHI study do not support this labelling. The results of the WHI study show that the administration of HRT increases the risks of stroke and pulmonary embolism. It is reasonable to think that in the case of bleeding, at least at weekends in nursing homes (when staff levels may be low) patients were immobilized in their beds. Immobilization among women on HRT could have been more dangerous than the HRT itself. Progestins need to be delivered to the endometrium in a manner that will have the least effect on the breast. Systemic administration can be replaced by releasing progestin locally in the uterine cavity. Endometrial protection with a levonorgestrel-releasing intra-uterine system (IUS) is well tolerated. The high hepatic concentrations of estrogens given orally could be avoided by transdermal administration. New studies should be planned to reflect the situation in clinical practice. The time to start HRT in healthy menopausal women is between the ages of 45 to 55 years.

Breast Neoplasms↗
PubMed2001

Progestin-releasing intrauterine systems.

The levonorgestrel-releasing intrauterine system (LNG IUS) is an effective method for contraception. It has a strong antiproliferative action on the endometrium. The endometrium is transformed under the influence of local levonorgestrel and becomes unresponsive to ovarian estrogens. This process is associated with progressive reduction of menstrual blood loss and menstrual duration. Scanty and irregular bleeding and/or spotting is usual during the first 3 to 4 months. The reduction of menstrual blood loss continues and after the first 9 months many women have no bleeding at all. However, they have normal ovarian function. The absence of bleeding is a result of the local antiproliferative action of the LNG IUS on the endometrium, which is also responsible for many health benefits during the use of this method. As with oral contraceptives, the risk of pelvic inflammatory disease is reduced, because of reduced menstrual blood loss, endometrial suppression, and thickening of the cervical mucus. There are some steroidal side effects: mood changes, oily skin, and acne. Weight increase is similar to that associated with copper intrauterine devices: 500 g per year over 5 years. Users should be told that the LNG IUS does not prevent sexually transmitted infection, and therefore women at risk should also use condoms for their protection.

Acne Vulgaris↗
PubMed2001

Therapeutic use of the LNG IUS, and counseling.

The intrauterine release of levonorgestrel (LNG) alters the function of the endometrium. This phenomenon offers special health benefits for users and a manner of local intrauterine therapy. In this review we discuss use of LNG-releasing intrauterine system (LNG IUS) in treatment and prevention of anemia and in the therapy of menorrhagia and dysmenorrhea. The antiproliferative effect of the LNG IUS on the endometrium offers targeted therapy against the proliferative action of estrogen on the endometrium during hormone replacement therapy. The LNG IUS as an alternative to sterilization is also discussed. There are also promising therapeutic fields such as use of the LNG IUS in the treatment of endometriosis and in the protection of endometrium exposed to tamoxifen during breast cancer treatment. Special attention is paid to counseling because successful use of the LNG IUS requires good training of the providers and extensive counseling of users.

Anemia↗
PubMed1997

Intracervical and fundal administration of levonorgestrel for contraception: endometrial thickness, patterns of bleeding, and persisting ovarian follicles.

OBJECTIVE(S): To study the prevalence of persisting ovarian follicles and to assess the endometrial changes and patterns of vaginal bleeding over 1 year of use of a 20 micrograms/24 h levonorgestrel-releasing intracervical contraceptive device. DESIGN: Prospective, randomized study. SETTING: Two family planning clinics in Helsinki, Finland. PATIENT(S): Women requesting intrauterine hormonal contraception. INTERVENTION(S): Insertion of a levonorgestrel-releasing intracervical contraceptive device into the cervical canal (group 1, n = 151) or fundally into the uterine cavity (group 2, n = 147) for contraception. MAIN OUTCOME MEASURE(S): Transvaginal ultrasonography of the ovaries and endometrium at insertion and 3, 6, and 12 months after insertion. Data on bleeding were collected using menstrual diary cards. RESULTS: Persisting ovarian follicles were found in < 8% of women. In both groups, the amount of endometrial tissue decreased significantly in 3 months. The incidence of amenorrhea during the 1st year was higher in the fundal insertion group. CONCLUSION(S): The number of persisting follicles was low. Follicles resolved within 6 to 8 weeks. No association was found between persisting follicles and problems of bleeding. Compared with intracervical insertion, fundal insertion resulted in more uniform endometrial suppression and fewer days of bleeding and spotting.

Adult↗
PubMed1996

A 12-month comparative clinical investigation of a levonorgestrel-releasing intracervical device situated in the uterine cavity or cervical canal.

A randomized study was performed in two clinics in order to compare the efficacy, safety and acceptability of a new model of a levonorgestrel-releasing intracervical device situated either in the cervical canal (group I) or in the uterine cavity (group II). Group I included 151 women (age 18-43) and group II, 147 women (age 19-43). The number of nulliparous women was 145. The total expulsion rate was 9.1%. The expulsion rate was lower among nulliparous women (4.8%) than among parous women (13.1%). There was also a significant difference in the expulsion rates between the two clinics. Two pregnancies occurred in both groups and two of these were ectopic, one in each group. The other two occurred after unnoticed expulsion. These figures give 12-month cumulative pregnancy rates of 1.3% and 1.4% in groups I and II, respectively. Total infection rate was 0.3%. The continuation rates were 82.1% in group I and 85.0% in group II after the first year. At three-month follow-up there were significantly fewer menstrual problems in group I than in group II (p = 0.0266). It is concluded that expulsion is still a problem with a small device but it may be diminished by intrauterine insertion and by selecting the users carefully.

Adolescent↗
PubMed1995

Levonorgestrel-releasing IUD as a method of contraception with therapeutic properties.

The levonorgestrel-releasing intrauterine device LNg IUD is a new contraceptive method that combines the advantages of both hormonal and intrauterine contraception. It gives users non-contraceptive health benefits and can also be used as an effective therapy for menorrhagia. The local release of LNg within the endometrial cavity results in strong suppression of endometrial growth as the endometrium becomes insensitive to ovarian estradiol. The endometrial suppression is the reason for a significant reduction of menstrual blood loss or amenorrhea, and for the disappearance of dysmenorrhea. The bleeding pattern during the use of the LNg IUD is characterized by reduction of the blood loss and in the number of bleeding days per cycle. During the first two to three months of use, however, irregular spotting is common. The removal of the device results in a quick return of menstrual bleeding and fertility. The failure rate of copper-releasing IUDs, as with other methods of fertility regulation, is higher in young women and decreases with age. The LNg IUD, on the other hand, has the same low pregnancy rate in every age group of the users. The LNg IUD also gives protection against ectopic pregnancy and pelvic inflammatory disease and, by reducing menstrual blood loss, increases the body iron stores. The LNg IUD can be used to effectively treat menorrhagia. This has been demonstrated in studies with quantitative determination of menstrual blood loss. During the first year of use, the LNg IUD reduced menstrual blood loss by 90% from pretreatment levels. Comparative clinical trials with the LNg IUD cover more than 10,000 women-years of follow-up during use over five to seven years. The Pearl pregnancy rate in studies has been 0.0-0.2 per 100 women-years. The overall ectopic Pearl pregnancy rate is 0.02 per 100 woman-years. The LNg IUD is marketed in Denmark, Finland, Norway, Sweden and in the United Kingdom.

Adolescent↗
PubMed1995

The effect of local intrauterine levonorgestrel administration on endometrial thickness and uterine blood circulation.

To evaluate non-invasively the role of levonorgestrel releasing devices in direct contact with the endometrium on menstrual spotting and endometrium inactivation, we inserted levonorgestrel releasing devices (20 micrograms/24 h) either into the cervical canal or the uterine cavity of 30 fertile women. Both before insertion and over the following 3 months, we used transvaginal sonography to measure the endometrial thickness in 20 of the women and Doppler flow to measure the uterine blood flow in the remaining 10 women. The women were asked to keep records of menstrual bleeding and they gave blood samples for the measurement of serum oestradiol, progesterone and levonorgestrel. By 10 weeks after insertion there was a significant decrease in endometrial thickness in both groups. Intracervical levonorgestrel release allowed the endometrium to maintain cyclic changes, whereas direct intrauterine levonorgestrel release eliminated the cyclical changes. The total number of spotting days was significantly less (P = 0.0249) in the intracervical release group at 3 months; 1.2 +/- 0.6 versus 8.1 +/- 1.8 (mean +/- SE). There were no significant differences in hormone concentrations between the groups. The pulsatility index did not change significantly during the study. We concluded that the inactivation process of the endometrium can be monitored by transvaginal sonography and that locally administered levonorgestrel does not change circulatory conditions detectable by Doppler flow. Our results also suggest that the inactivation process of the endometrium is different between intracervical and intrauterine levonorgestrel administration and may explain the difference in the number of spotting days.

Adult↗
PubMed1993

Sequential regimen of the antiprogesterone RU486 and synthetic progestin for contraception.

OBJECTIVE: To examine the effect of sequential use of the antiprogesterone RU486 and synthetic progestin on ovarian function of healthy women. DESIGN: Healthy women were given a sequential antiprogesterone-progestin treatment. Blood samples were taken twice a week during one control cycle and one to three treatment cycles; prospective analysis. SETTING: The outpatient clinic of the Helsinki City Maternity Hospital, Helsinki, Finland, and Steroid Research Laboratory, Department of Medical Chemistry, University of Helsinki, Helsinki, Finland. PATIENTS: Eleven healthy women, volunteers, 20 to 34 years of age. INTERVENTIONS: A dose of 25 mg/d of RU486 was given during cycle days 1 to 21, and synthetic progestin (5 mg of norethisterone to six and 5 mg of medroxyprogesterone acetate to five women) during cycle days 22 to 31. MAIN OUTCOME MEASURES: Serum P, E2, FSH, and LH were measured from serum samples. RESULTS: In 20 of the 24 treatment cycles analyzed the serum concentrations of P were anovulatory. In the remaining 4 cycles, P levels rose above 3 ng/mL, suggestive of ovulation. Folliculogenesis was not completely inhibited, but serum E2 profiles were subnormal and delayed. Bleeding control was satisfactory. CONCLUSIONS: Antiprogesterone RU486 hampers or delays follicular development, suggesting a possible use as an estrogen-free oral contraceptive. However, the synthetic progestins used in this regimen induced serum P rises in some cycles. The synthetic progestin provides the cycle control, but its possible effect on the reliability of the method remains to be evaluated.

Adult↗
PubMed1992

Contraception after thirty-five.

Our knowledge about the safety, the incidence of side effects, and the effectiveness of contraceptive methods for women in premenopause, or during the last decade of their reproductive life, has not been a primary interest for research and development in fertility control. The main purpose of trials for the evaluation of new contraceptive methods is to test their effectiveness, and therefore only women below 38 years of age are accepted. Furthermore, when new methods are being tested, only healthy women are accepted, and those having health problems of almost any kind are excluded. Therefore our knowledge about the contraceptive methods in women over 40 years of age is scanty and comes from trials with a long-lasting follow-up on healthy women who can use the method without problems until they are 45 or reach menopause. We have very limited reported information on the use of contraceptives by women who have cardiovascular disease, diabetes, liver problems, etc. Therefore the main body of experience in this review comes from healthy women between 35 and 44. On the other hand, one should remember that these women have a high motivation to use contraceptive methods and therefore the continuation rate in the trials is high. This compensates for the relatively small number of acceptors by giving more women-years in follow-up. Continuation rate and the proper use of methods are directly correlated to increase in age, socioeconomical status, and to education of users. Highly educated women in this age group have very low failure rate with almost any method.

Adult↗
PubMed1991

Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years' comparative experience of levonorgestrel- and copper-releasing intrauterine devices.

A randomized, multicenter comparison of two intrauterine contraceptive devices (IUDs) was carried out. Nine hundred thirty-seven women were fitted with a copper-releasing IUD, the Nova-T, and 1821 women with an IUD that releases 20 micrograms of levonorgestrel daily. After 36 months, the cumulative gross rates of amenorrhea and hormonal side effects were significantly higher in the levonorgestrel-IUD users. The cumulative 36-month gross pregnancy rate was 3.7 for the Nova-T and 0.3 for the levonorgestrel IUD (P less than .001), demonstrating the levonorgestrel IUD's high contraceptive efficacy. For the first time, a protective effect of the levonorgestrel IUD against pelvic inflammatory disease as compared with the Nova-T was seen statistically. The cumulative 36-month gross rate of pelvic inflammatory disease was 2.0 in Nova-T- and 0.5 in levonorgestrel-IUD users (P less than .013). This significantly lowered incidence of pelvic inflammatory disease may help to solve one of the major concerns associated with intrauterine contraception.

Adult↗
PubMed1990

Pharmacokinetic and pharmacodynamic studies of levonorgestrel-releasing intrauterine device.

Intrauterine devices releasing 20 micrograms/day levonorgestrel were inserted in 10 women (ages 25-34). Bleeding and spotting patterns were recorded on a menstrual card during one year of follow-up. Blood samples were collected for radioimmunoassays of LH, estradiol (E2), progesterone (P) and levonorgestrel (LNG) and for sex hormone binding globulin (SHBG) 3 times a week during the 1st month of use, and twice a week during the 6th and 12th treatment months. Among the 10 women, two experienced irregular cycles with prolonged intermenstrual spotting, four had amenorrhea in the latter part of treatment months, while the other four had regular cycles. According to the serum levels of E2 and P, the hormone profiles were divided into four types of reaction: A) anovulatory, B) anovulatory but with high follicular activity, C) ovulatory but with luteal insufficiency, and D) ovulatory. Among the 29 treatment cycles, there were 10 D-type, 3 C-type, 13 B-type and 3 A-type of ovarian reactions: 44.8% of the cycles were ovulatory (C + D) and 55.2% were anovulatory (A + B). In general, serum levels of levonorgestrel were low in ovulatory cycles and were high in anovulatory cycles. The difference was statistically significant. There were marked individual differences. The decline of serum LNG from the 1st (492 pmol/l) to the 6th (320 pmol/l) treatment months was 34.9% on average. The amenorrheic cycles coincided mostly with the hormonal profile of ovulatory types, which indicated that the cause of amenorrhea is due to the local effect of levonorgestrel on the endometrium. The levonorgestrel levels were significantly correlated with serum SHBG, r = 0.8856, p less than 0.001, and with E2, r = 0.4661, p less than 0.05.

Adult↗
PubMed1990

Comparison of the clinical performance, contraceptive efficacy and acceptability of levonorgestrel-releasing IUD and Norplant-2 implants in China.

The levonorgestrel-releasing IUD (LNG-IUD, 20 micrograms/d) and the Norplant-2 implants were studied in a randomized comparative clinical trial with 200 women for one year. No pregnancy or expulsion occurred with the Norplant-2. In the LNG-IUD group, there was one pregnancy at the 12th month of use after an unnoticed expulsion. The net cumulative pregnancy and expulsion rates of LNG-IUD were 1.0 and 3.0. The removal rate due to menstrual disturbances in both LNG-IUD and Norplant-2 groups was 3.0. The use-related discontinuation rates were 9.0 and 3.0, and the continuation rates were 90.0 and 96.0, respectively. The differences were not statistically significant. Menstrual disturbance was the main side effect. It was improved after long time use, especially in the LNG-IUD group. After one year, the percentages of women with amenorrhea were 18.9 for the LNG-IUD and 8.3 for the Norplant-2. The menstrual blood loss was statistically significantly reduced in the LNG-IUD group, and blood haemoglobin concentration increased in both groups. The LNG-IUD and Norplant-2 are highly effective, safe, long-acting, and well accepted by the Chinese women.

Administration, Intravaginal↗