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The effects of hormonal contraceptive agents on the vascular system were studied in rats, dogs, and 34 women taking oral or injectable steroid contraceptive agents. Changes in the surface charge characteristics of the blood vessel wall and blood cells were observed. In dogs, the reduction in pore surface charge was greater in veins than in arteries. In rats, the induced mesenteric occlusion times were significantly reduced (p less than .001). However, Provera did not significantly reduce induced occlusion time in these animals (p greater than .01). Ov ral and Demulen lowered the mobilities of erythrocytes and platelets in women. Plasma coagulation times were not markedly altered in women receiving injectable progestin. Acitivated partial thromboplastin times were slightly decreased by Ovral and Demulen. The results suggest an increased tendency toward thrombosis in women taking steroid hormone contraceptive agents.
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PMID:Hormonal steroids: effects on the vascular system. 121

The US Food and Drug Administration (FDA) has not approved any injectable contraceptives, but, in December 1990, it approved Norplant, an implantable contraceptive. Family planning providers insert 6 capsules, each with 36 mg levonorgestrel, in a fan shape under the dermis of the upper arm. Norplant protects against pregnancy for at least 5 years . Fecundity returns within 2 weeks after capsules' removal. The steady low levels of levonorgestrel keep down both luteinizing hormone and follicle stimulating hormone levels. It suppresses ovulation and thickens the cervical mucus. Contraindications of Norplant are active thromboembolism, undiagnosed genital bleeding, acute liver disease, liver tumors, and breast cancer. Phenytoin and other drugs which speed up liver metabolism reduce Norplant's efficacy. The leading side effect of Norplant is irregular bleeding patterns. Some less common side effects include headaches, nervousness, dizziness, and acne. First year continuation rates range from 76 to 99% and 25 to 78% for 5 years of use. More than 85% of Norplant users are satisfied. Both continuation and satisfaction are associated with patient counseling. Research and development of biodegradable and other nonbiodegradable implants is ongoing. The most common injectable contraceptive in the world is Depo-Provera. 150 mg of Depo-Provera every 3 months suppresses ovulation, deteriorates the endometrium, thickens cervical mucus, and reduces motility of the tubes, thereby providing adequate protection against pregnancy. Some research shows Depo-Provera use significantly increases the low-density lipoprotein to high-density lipoprotein ratio, thereby increasing the risk for atherogenesis. Effectiveness rates match those of Norplant. Norethindrone enanthate was the first injectable contraceptive. Even though 40 countries approve it, the US does not. Animal studies of injectable microspheres or microcapsules with either progestogen or progestogen and estrogen are in progress.
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PMID:Injectable and implantable contraceptives. 138 11

The mechanism of action, low and high failure rates, and some of the adverse effects for the commonly used methods of contraception are listed. These include the use of spermicide alone, sponge with spermicide, withdrawal, periodic abstinence, diaphragm or cervical cap with spermicide, condom, combined and progestin oral contraceptives, progesterone T and copper T 380A IUDs, medroxyprogesterone acetate (Depo-Provera), and levonorgestrel subdermal implants (Norplant). Each method is briefly described with reference to relevant published papers and studies. An extensive list of combined oral contraceptives is also presented with estrogen and progestin component data, as well as the cost of each drug to the pharmacist for one month's use based upon average wholesale price listings in Drug Topics Red Book 1992 and November Update.
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PMID:Choice of contraceptives. 144 19

US women over 35 years old continue to need reversible contraception. Most women in this age group who need reversible contraception use the condom, diaphragm, spermicides, IUDs, or oral contraceptives (OCs). The most effective reversible contraceptives are OCs, the IUD, and the systemic contraceptive, Norplant. Healthy women older than 35 who do not smoke and have no coronary artery disease risk factors can safely use low-dose OCs. OCs do not increase the incidence of breast cancer. They appear to protect from epithelial ovarian neoplasm and functional ovarian cysts. Further, they reduce the amount and duration of vaginal bleeding. IUD use has fallen in the US due to the negative publicity of increased risk of pelvic inflammatory disease (PID). Studies have shown, however, that older women who are in a stable monogamous relationship can use an IUD without increasing their risk of PID. The only 2 IUDs available in the US are Progestasert, which releases progesterone, and Paragard T380A, which releases copper. Progestasert reduces the amount of bleeding often associated with IUD use. The risk of ectopic pregnancy is slightly increased in IUD users. Older women can choose the subdermal implant, Norplant, which is effective for 5 years. Its major disadvantage is irregular vaginal spotting or bleeding, but administration of oral estrogen controls this effect. Norplant suppresses ovulation and alters cervical mucus.
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PMID:Reversible contraception for the woman over 35 years of age. 145 Mar 55

Well over 100,000,000 women have used the combined oral contraceptive (OC) pill. As a result of the population explosion in the 1970s and 1980s, there will be almost one third more women in fertile age in the year 2000 than in 1991. In the developing world outside China, the total number of contraceptive users could double in roughly 10 years. China, the total number of contraceptive users could double in roughly 10 years. The pill has a low failure rate, but one study in Egypt found that 90% of women made errors in moving from one packet to the next. Similarly, a 60% error rate was found among users in Colombia. The vaginal ring delivers combined progestogen and estrogen through a silastic wall. The device can be left in place for 21 days out of 28, and such delivery would virtually eliminate the low risk of hepatocellular carcinoma among OC users. A vaginal progestogen ring is being tested. Over 700,000 women have used Norplant, the subdermal implant method with an effectiveness rate of 99%. Depo-provera and norethindrone enanthate injections last 2 to 3 months. The Progestasert IUD, containing 38 mg progesterone released at a rate of 65 mcg per day, is effective. Progesterone-releasing IUDs lasting from 3 to 5 years could complement subdermal implants. Ethinyl estradiol (205 mg) and diethylstilbestrol (25-50 mg) have both been used as postcoital agents taken within 36 hours for 5 consecutive days after unprotected intercourse. In more than 3000 cases there were 17 pregnancies (.05%). These regimens are replaced by giving combined oral contraceptive tables (e.g., .25 mg d-norgestrel and 50 mg ethinyl estradiol), taken 2 at a time and repeated 12 hours later, within 72 hours of unprotected intercourse. Epidemiological studies have confirmed that the use of the combined oral contraceptive for 3 to 5 years halves a woman's risk of ovarian or endometrial cancer, and the protection persists for 10 to 18 years after cessation of use.
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PMID:The future of hormonal contraception. 168 5

Weight gain and psychomotor development of breastfed infants of Egyptian mothers using Norplant, Cu T-380A IUDs, norethisterone enanthate injectables (NET-EN), Depo Provera and a levonorgestrel minipill were compared in 2 trials. First, groups of 120 women using Norplant and NET-EN were compared to a control group using IUDs, beginning 5-7 weeks postpartum. There were no differences in infant weight gain, mid-arm circumference, triceps-skin-fold thickness, or timing of motor milestones. The mean growth curve of all 3 groups were close to that of the 50th percentile for Egyptian infants. While timing of initiation of supplements was similar in the 3 groups, complete weaning occurred first in the IUD group, second in the Norplant group, and last in the NET-EN users. A second trail compared progesterone implants injected with a trocar that resulted in a blood level of 3 ng/ml for 5 months, with Population Council vaginal rings releasing 10 progesterone/24 hours, and CuT-380A IUDs. Serum progesterone in the ring users averaged 5.2 ng/ml for the 1st 2 weeks, then leveled off at about 4 ng/ml for about 2 months, falling to about 3 ng/ml for the last 3 weeks of use. Each women used 4 rings per year. Evidence of ovulation by ultrasonic vaginal probe and assay of estradiol and progesterone was apparent in 25% of vaginal ring users, compared to 55.9% of controls in the 2nd 6 months postpartum. There was 1 pregnancy in a ring users. The continuation rates were 66.6% for rings and 85.5% for IUDs. The reasons for discontinuation in vaginal ring continuation were logistical problems and unfamiliarity.
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PMID:Contraception with progestogens and progesterone during lactation. 183 50

In 1989, researchers conducted a situation analysis of 100 service delivery points (SDPs) in Kenya. They wanted to evaluate the usefulness of collecting and analyzing data on factors that influence the impact of family planning (FP). FP workers took a gynecological history and blood pressure on 96% of new clients and did a pelvic exam on 73%. 80 SDPs had Depo-Provera and foam tablets on hand and 85 had condoms. Even though the Ministry of Health had 8 varieties of oral contraceptives (OCs), not all SDPs had all types. 97 SDPs had the OC Microgynon, yet 24 had 10 cycles. 53 SDPs had at least 1 FP poster on the wall. 38 had charts or other educational aids. None provided educational material for the clients to take home with them. 32 SDPs had health talks and only 16 addressed FP. 1 on 1 client counseling made up somewhat for this lack of information (31% of clients interviewed reported the clinic as their 1st source of FP information). Yet the SDP workers often did not tell clients about contraindications, complications, and how to manage complications. Supervision was minimal. 87 SDPs kept records on FP clients. 81 SDPs had referred some women for FP services. Only 54% of the nurses and midwives attended the core 7 week training course in FP designed to certify them to deliver FP services. A mean of 9443 clients attended these SDPs each month. 71% used OCs, 19% Depo-Provera, 5% condoms, and 5% IUDs and foam. 94% of clients learned of 2+ methods at the SDPs, especially OCs and Depo-Provera. FP workers provided little information about sterilization. The researchers observed the quality of care indicators on an 1 client/clinic basis which probably biased the results in a positive direction. Nevertheless, FP workers did know how to provide acceptable good care. These results showed that the quality of FP in Kenya should be upgraded from weak and poor to moderate to moderately high.
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PMID:The Situation Analysis Study of the family planning program in Kenya. 194 97

The Fertility Control Clinic, National University Hospital in Singapore carried out this study between Jan.1988-Dec.1988. In a comparison of present and past users of contraceptive implants (Norplant) or injectables (DMPA) and discontinuers of Norplant or DMPA, information concerning the women's knowledge and perception of, and attitude to, implants and injectable contraceptives, was studied. 200 married women ages 20-45 with at least 1 living child, who had used either method for at least 1 year, took part in this survey. The long duration of action (5 years) of implants was perceived positively by all groups as compared to the shorter 3-month duration of injectables, though this was seen as an advantage over the pill. 69% of implant users expressed a desire to continue using them, but only 30.7% of the injectable users wanted to continue using the method. 60% of the injectable users wanted to switch to implants, whereas no implant users desired a change. Women stopped using these 2 methods mainly because of the desire for a future pregnancy, menstrual spotting, and absence of menses. Norplant seems to be the ideal contraceptive in Singapore for women who do not want any more children or irreversible contraception.
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PMID:Attitudes towards contraceptive implants and injectables among present and former users in Singapore. 210 23

Oral contraceptives (OCs, long-acting progestins (LAPs), and IUDS are reviewed in terms of new information on safety and efficacy. OC formulations are described and their mechanism of action and efficacy indicated. Reports are provided for thromboembolism, hemorrhagic and thrombotic stroke, ischemic heart diseases, alterations in lipid and hypoprotein and carbohydrate metabolism, hypertension, coagulation changes, breast and cervical cancers, and such minor side effects as menstrual irregularities, nausea, headaches, weight gain, premenstrual syndrome effects, and mood and libido changes. Noncontraceptive health benefits and clinical considerations are discussed. Norplant, as the only long acting progestin available in the US is described in terms of its formulations, mechanism of action, sequelae and metabolic effects, menstrual irregularities, metabolic effects, nuisance side effects, candidates for insertion, method of insertion and removal, and continuation rates. 2 IUD types are identified as the only ones available in the US, Progestasert T and T-Cu-380A (Paragard). Mechanism of action, efficacy, candidates, major sequelae such as salpingitis, infertility, and uterine perforation, minor sequelae such as metrorrhagia and dysmenorrhea, and other considerations are indicated. OCs in the US contain an average of 35 mg of ethinyl estradiol and assorted progestins e.g.s, ethynodiol diacetate, norethindrone acetate, nortestosterone derivatives with a complex mechanism of action. The failure rate for use effectiveness is 6 pregnancies/100 woman years. Modern formulations have combined rates of no more than 50 to 100 adverse events/100,000 users. Some of the effects are indicated as follows: Thromboembolism accounts for 60% of adverse effects and appears to be declining along with hemorrhagic and thrombotic stroke, however, modern use studies are only partially available. Myocardial infarction related to OC use may be embolic, and has a low risk at 7/100,000 users. Low-dose contraceptives substantially reduce the associated risks. Those with risk factors need close monitoring. Norplant is useful for those not wanting to take a daily regimen and is commonly accompanied by menstrual irregularity and sometimes headaches. Continuation is 80% after the 1st year and 40% after 5 years. Candidates for IUDs are parous women in monogamous relationships, who are not at risk for salpingitis, which is related to IUD use, or sexually transmitted diseases. Continuation is 70% after 1 year compared with 50% of OC users.
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PMID:Modern trends in contraception. 212 11

Researchers followed 68 women who attended the Family Welfare Clinic at the Kenyatta National Hospital in Nairobi, Kenya to determine if the low estrogen combined oral contraceptive (OC) Microgynon, a progestogen only OC, and Depo-Provera induce changes in the oral glucose test. These women did not take any steroidal contraceptives before entry into the study. Blood glucose levels were significantly higher after 60, 90 and 120 minutes than the control levels for women taking Microgynon. In addition, the mean areas under the glucose curves were substantially elevated after 1, 3, and 6 months above the control (p.002, .005, and .01 respectively). The only significant change in blood glucose levels in women taking the progestogen only OC occurred at 30 minutes after 6 months. Yet the mean areas under the curve were significantly higher than the control after ,1 2, and 3 months (p.005, .05 and .002 respectively). As for Depo-Provera, significantly lowered blood glucose levels only occurred after 1 month at 30, 50, and 90 minutes although no significant changes occurred after 1, 3, and 6 months in the mean areas under the glucose curves. Metabolic change occurred earlier and more often in Microgynon users than progestogen only OC users. This could be due to the progestogen levonorgestrel which has been shown to interrupt glucose metabolism. These changes could possible adversely effect women who are predisposed to developing diabetes, since 1 woman did develop a diabetic curve after 1 month of using Microgynon. Nevertheless no pattern towards abnormal glucose tolerance existed. Standard deviations of areas under the curves indicated that the number of women who develop glucose intolerance may increase with duration of use.
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PMID:The effect of low-oestrogen combined pill, progestogen-only pill and medroxyprogesterone acetate on oral glucose tolerance test. 214 46


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