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Most of the scientific community, as well as in a sector of international Law, when referring to the unborn embryo, pregnancy must be defined as the period extending from implantation to natural birth. This implies some novelty, such as the redefinition of abortion as the elimination of the embryo only within this period, and the extension of contraception to any means that impedes the union of the gametes as a consequence of a sexual intercourse, or also that which eliminates the product of conception prior to its implantation. Therefore, the pharmaceutical industry markets, under the name of contraceptives, products that act also by means of an anti-implantation mechanism. This fact has great ethical implications regarding the respect for the embryo which require a reflection on the moral valuation of the prescription, dispensation and use of these means. One may ask: which of the contraceptive means actually present in the market include an anti-implantation effect? What mechanisms contribute to their pharmacological action and in what measure do they do this? This is what we have studied in this article, based on the available scientific bibliography. We have basically fulfilled a double objective: updating and completing the studies -few, partial or distant in time- that had this same subject matter; and offering a moral valuation on the use of hormonal contraceptives that may have an anti-implantation effect, from the point of view of the respect due to the embryonic life.

Background: Cervical cancer has been extensively studied, as well as the various risk factors for that cancer. One such factor is the prolonged use of hormonal contraceptives., Objective: To report the biological, immunological and epidemiological findings arising from the use of oral contraceptives and their relation to cervical cancer., Material and Methods: Retrospective study based on information published in national and international literature., Conclusions: Controversy persists between the epidemiological data and experimental biological association between hormonal contraceptives and cancer induced by HPV. It is important to consider the biological findings because in Mexico the use of hormonal contraceptives is very broad and the number of cases of cervical cancer and only extensive epidemiological studies will clarify this controversy.

Objective: To compare the bleeding patterns, satisfaction and tolerability of 3 different contraceptive in an extended regimens in the service of Family Planning of the North Central Hospital of PEMEX., Material and Methods: Healthy, adult women with desire of contraception for one year (N 120) were randomly assigned to receive oral contraceptive drospirenone/ethinyl E2 (group1), the norelgestromin/ethinyl E2 transdermal patch (group 2) and vaginal ring etonogestrel/ ethinyl E2 (group 3) in an extended regimen (42 consecutive days, 1 hormone-free week). Study assessments were conducted at scheduled visits at the time of initial screening, at baseline after 1, 3, 6, and 12 months. Subjects recorded menstrual associated symptoms bleeding data and completed satisfaction questionnaires. Subjects and investigators provided overall assessments of the regimens., Results: Extended use of 3 different contraceptive resulted in fewer bleeding days in every group (66.6%, 55% and 58.3% P 0.0024), and less mastalgia and menstrual pain. Subjects were highly satisfied with three regimens (93.3%, 96.6% and 91.6% P 0.00421). Although not mayor adverse events were reported with this regimen, there was an increase in spotting days; it decreased with each successive cycle of therapy. Efficacy and safety were similar to those reported for traditional cycle., Conclusion: Extended-contraceptive regimen delays menses and reduces bleeding, a profile that may be preferred by women who seek flexibility with their contraceptive method.

Etravirine (ETR) belongs to the family of non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs), with antiviral activity in patients with resistance to first-generation NNRTIs. The drug interactions caused by ETR are due to its dual effect on the CYP450 system. ETR acts as an inducer of CYP3A4 and inhibitor of CYP2C9 and CYP2C19. This drug shows few clinically significant drug interactions, the most important of which involve the unboosted protease inhibitors, the NNRTIs efavirenz and nevirapine, full-dose ritonavir and tipranavir/ritonavir. Interaction with fosamprenavir/ritonavir is not clinically significant, although their plasma levels vary slightly when used in combination with ETR. ETR shows no interactions with darunavir/ritonavir., (2009 Elsevier España S.L. All rights reserved.)

Darunavir is a new HIV protease inhibitor that has been shown to be highly useful in HIV-infected patients. This drug is primarily metabolized by the liver through the cytochrome P450 3A4 (CYP3A4) isozyme and consequently coadministration with low doses of ritonavir markedly increases exposure and allows both daily doses and pill burden to be reduced. Both darunavir and ritonavir act as inhibitors and substrates of CYP3A4 and may therefore present pharmacological interactions with a large number of drugs commonly used in HIV-infected patients. The present review aims to summarize the main studies that have evaluated drug interactions and to provide recommendations on treatment with darunavir/ritonavir in clinical practice.

Objective: To study the influence of oral contraception use as risk factor for human papillomavirus infection (HPV) and progression to cervical intraepithelial neoplasia (CIN)., Materials and Methods: A prospective, transversal and comparative study of 84 female patients in reproductive age that had used oral contraception for more than three years as birth control method and who had CIN mild (CIN I), moderate (CIN II) or severe (CIN III) associated or not to HPV infection documented by colposcopy, pathology and cytology was done. 84 cases and 60 controls submitted to a directed interrogation were studied. Differences among groups were determined by linear regression, multivariance and logistic regression tests, p <0.05 was considered statistically significant., Results: Average age for cases and controls was 37.5 and 36.2 years, respectively. The 70% of patients started their active sexual life in the second decade of their life. The most frequent age was 18 and 19 years. 50.6% of these patients had more than one sexual partner, two in average. 67.8% of cases had HPV infection and applying the multivariance analysis: sexual partners (p < 0.05), age at first pregnancy (p < 0.05) and oral contraception use (p < 0.05) were considered statistically significant. According to the CIN grade, the HPV presence was found as highly statistically significant (p < 0.001). Oral contraception use was found as risk factor for HPV infection by logistic regression (p = 0.0242); OR = 3.2714; CI = 1.1670-9.1702. As for the CIN degree, HPV presence was found as highly significant (p = 0.0001); OR = 2.4158; CI = 1.7150-3.4028., Conclusion: A high incidence of HPV was found in our study. This is an important risk factor during cellular transformation, so the use of oral contraception as birth control method could accelerate the viral oncogenes expression present in HPV cellular genome. It is highly recommended to discard HPV infection before prescribing oral contraception as birth control method.

Objective: To study the evolution of antithrombin (AT) and plasma fibrinogen levels and of hematologic values among women in child-bearing age on treatment with the new hormonal oral contraceptives (HOC): in microdose, ultramicrodose and Diane-35., Method: Retrospective review of 100 randomized cases out of a total registry of 1,245 clinical records., Results: The mean age in our series was 23.4 years (range: 18-39 years). The mean study time was 3.3 years (range: 1-5 years). During the study period, there was not a single woman with an AT lower than 70%. There were no significant changes at the end of the study period regarding AT, plasma fibrinogen, hematocrit, hemoglobin, prothrombin activity and activated partial thromboplastin time. A significant decrease was observed for platelet count (246,113 5,842 vs. 215,636 4,383 platelets/mm3; p = 0.003). There was not a single case of thrombocytopenia registered. No relevant differences were observed between the treatment groups with microdosaged, ultramicrodosaged and Diane-35., Conclusions: At mid-term (3.3 years), the new HOC (in microdose, ultramicrodose and Diane-35), do not cause significant changes in AT, plasma fibrinogen, hematocrit, hemoglobin, prothrombin activity and activated partial thromboplastin time. In our series, a moderate but significant decrease in the platelet count was observed but there were no cases of thrombocytopenia. The effect of the different new HOC on the studied parameters was similar.

The most frequent progestins used as contraceptives with or without estrogens and their effects on glucose tolerance tests and insulin secretion is reviewed. Although changes observed were moderate, they became normal after few cycles of contraceptive use. All combined contraceptives (progestin plus ethynyl estradiol) produced some deterioration of glucose in the tolerance tests and increase in insulin secretion, although these changes were within normal accepted levels. The most notable changes were seen with levonorgestrel, mono or thiphasic, and were minimal with desogestrel or gestodene. No changes occurred with pregnane type compounds, like medroxy progesterone acetate, with no estrogens as the most representative of this group. The determinations of insulin secretion are more reliable if peptide C in plasma is determined, as it is released by the pancreas in an equimolar amount with insulin and is not retained by the liver.

Al oral monophasic contraceptive formulation containing gestodene (75 mcg) and ethynilestradiol (30 mcg) is evaluated concerning its safety, efficacy and cycle-control. Sixty-seven healthy women were included, allowing a total of 574 evaluable cycles. This formulation showed a high degree of efficacy, with no pregnancies after its utilization. Side affects were similar or lower to other reported with another hormonal contraceptive oral formulations. Hematologic, biochemical or urinary parameters were not altered. An acceptable menstrual pattern was maintained. In conclusion, this formulation constitutes an oral contraceptive with a high efficacy rate, a well degree of acceptability and with a side effects profile similar or lower than those produced by other oral contraceptives.

The numerous pregnancies that occur as early as the first cycle after the discontinuation of an oral contraceptive prove that in general ovulation reappears immediately and that after a period of "rest" more or less prolonged the ovaries reasume their normal function very rapidly. However, in less than 1% of the cases the discontinuation of oral contrecption is followed by anovulation or even amenorrhea. The authors try to find an explanation to this over supression syndrome and review the different treatments that have been proposed in the bibliography, but keeping in mind that within a year 14% of the anovulations and 5% of the amenorrbeas will have disappeared spontaneously.

The aim of this report is to offer an explanation for the high incidence of arterial hypertension in women taken hormone contraceptives. The real incidence of this association has been considered in women initially having a normal blood pressure and in others who had high blood pressure before using these contraceptives. The estrogen and progestogen components in hormone contraceptives were analyzed individually in various studies. The most recent investigations seem to indicate that progestogen is the main cause of high blood pressure. Different mechanism that could link hormone contraceptives to high blood pressure were investigated. The renin-angiotensin-aldosterone axis involving the action of estrogens and progestogens on the renin substrate, plasma renin, angiotensin II and aldosterone were analyzed. Another possible mechanism could involve glucocorticoids, altering the metabolism of glucose, pyruvate, cholesterol, and triglycerides, Kidney disease involving renal function, microangiopathic anemia, and renal thromboembolism; hyperactivity of the sympathetic nervous system (noraepinephrine and dopamine-beta-hidroxylase blood levels); prostaglandins; genetic mechanism; and individual mechanism were all taken into consideration. Lastly the priorities of the different systems linking high blood pressure to hormone contraceptives and the relationships between them are analyzed.