Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Norplant consists of 6 soft plastic capsules placed in the subcutaneous tissue on the inside of the upper arm which release levonorgestrel continuously over 5 years to prevent pregnancy. Health workers use an aseptic technique to insert the capsules within 0.5 cm of the incision. Scar tissue increases removal time to twice that of insertion time. The 1st year pregnancy rate is 0.2%. Body weight affects the cumulative 5-year pregnancy rate: 0.2% for 50 kg women, 3.4-5% for 50-69 kg women, and 8.5 for 70 kg women. It rises remarkably in the 3rd year. Women find the advantages to be, in order of importance, ease of use, effectiveness, long duration, reversibility, and arm placement. The most common misconception about Norplant is it causes cancer or sterility. Both before insertion and during the early months after insertion, family planning providers must thoroughly explain Norplant and stress how it is different from other contraceptive methods. 1 study reveals that the 1-year continuation rate for women who undergo careful preinsertion counseling is greater than it is for women who do not receive effective counseling (88% vs. 60%). The leading side effect is abnormal bleeding patterns. Even though bleeding patterns change, hemoglobin or ferritin levels do not decrease. In women who experience no bleeding, providers must conduct a urinary human chorionic gonadotropin test at 4-6 weeks. If the test reveal no pregnancy, they need to explain to the women that this is normal. Abnormal bleeding patterns improve with increased duration of Norplant use. Women who need to be carefully monitored or should not use Norplant are those with impaired glucose tolerance, hyperlipidemia, impaired liver function, premenstrual symptoms, and history of depression. The ideal candidate is a woman who has used oral contraceptives (OCs) with no side effects yet forgets to take them daily, has contraindications for estrogen, or has estrogenic side effects from OCs.
 ...
PMID:Who is a candidate for Norplant? 161 60

Norplant capsules and Norplant 2 rods contain levonorgestrel (LNG) that is released slowly for up to 2000 days. After removal the progestogen vanished from the blood stream within 96 hours, and fertility is restored in contrast to the pill contraceptives. Norplant provides a cervix barrier against spermatozoa. About 1/2 of women taking it had anovulation or luteinization of unruptured follicles. In ovulating women the midluteal progesterone values were clearly reduced. There have been some reports concerning the increased aggregation of thrombocytes and the decline of high density lipoprotein (HDL) cholesterol levels in Norplant users. Thrombosis, cerebro- and cardiovascular accidents have not been reported. A longterm prospective study of Norplant 2 users showed an unacceptably high rate of pregnancies after the 4th year, thus the rods have to be replaced after 3 years instead of 5 years. 23% of Norplant 2 and 41% of Norplant users had to resort to removal because of side effects. 54% of Norplant and 48% of Norplant 2 users halted use after 3 years because of menstrual disorders, irregular bleeding, depression, and mood changes. LNG has high affinity to sex hormone binding globulin (SHGB), and it is not active in bound form. The free LNG index was lower in women with unwanted pregnancies than in other women. In 1989 the Population Council reported on 7 phase-3 investigations involving 2470 women. Only 398 completed the 5-year observation period: the cumulative pregnancy rate was 3.5, there were 3 pregnancies among those with body weight of 50-60 kg and 8.6 pregnancies among those weighing 70 kg or more. There were 101 unwanted pregnancies, and 1 child was born with intersexual genitals. Endometrium biopsy or curettage is advised in the event of irregular bleeding especially in women over 40, and about 25% of Norplant users have undergone these procedures.
 ...
PMID:[Norplant]. 210 34

In the US, the 90% of women, at risk of pregnancy, who use contraceptives account for 47% of all unplanned pregnancies. Thus, if women using no contraceptives or using user-dependent methods were to switch to long-acting hormonal contraceptives like Norplant or injectables, unplanned pregnancy rates would drop. Norplant was approved for use in the US in 1992. The device consists of six rods that release levonorgestrel over a period of five years to suppress the luteinizing hormone surge responsible for ovulation and thicken cervical mucus to prevent sperm penetration. Norplant is highly effective, results in few metabolic changes in users, and can be used by lactating mothers. Side effects (most prevalent in the first six months) include abnormal bleeding, weight gain, depression, and headaches. Adolescents studied reported overall satisfaction with the method. Difficulties with removal can be minimized if the implants are inserted properly. The injectable use of depot medroxyprogesterone acetate (DMPA) was approved in the US in 1992. Contraceptive plasma levels are reached within 24 hours of the injection and are maintained for 14 weeks. DMPA inhibits ovulation and is highly effective when administered once every three months. DMPA is associated with a longer delay in return to fertility than other methods. The side effects of DMPA are similar to those seen in Norplant users. Concern about changes in bone density are currently being investigated. DMPA users have increased low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels as compared to IUD users. DMPA (unlike Norplant) can be used effectively in women using anticonvulsant medications or antibiotics. It is also safe during lactation. Research into hormonal methods is being concentrated on the development of a two-rod and one-rod Norplant delivery system, on biodegradable delivery systems, and on various injectable formulations, including once-a-month estrogen/progesterone combination methods.
 ...
PMID:New contraceptives in the 1990s. 758 38

To learn more about the side effects associated with Norplant use in adolescence, the charts of 110 women 13-21 years of age (average, 17.2 years) who received the implants through hospital-based adolescent gynecology clinics in Arkansas were reviewed. The implants were inserted between March 1991 and February 1993; the mean length of time since insertion was 12.7 months (range, 8-19 months). 64% of Norplant acceptors were African-American. Weight and blood pressure measurements were obtained at baseline and at three follow-up periods: 1-4 months, 5-7 months, and 8 or more months. Overall, the average weight gain was 3.3 kg, but there were significant racial differences. At follow-up one, African-American females showed an average weight gain of 1.4 kg compared to no gain among White females. At follow-up three, the mean weight gain was 5.4 kg for African Americans and 2.6 kg for White youth. 37% of all participants reported no change in menstrual patterns, 28% experienced irregular (mainly light) bleeding, and 13% were amenorrheic; no data were available for the remaining 22%. There were no significant changes over time in blood pressure, and acne and depression were each recorded in only one chart. Three women requested Norplant removal during the study period. Overall, the findings of this study suggest that Norplant-related side effects may be less severe among adolescents than adult women, most notably the incidence of bleeding irregularities (82% in adult Norplant acceptors). To ensure Norplant continuation, however, adolescents should be counseled about the possibility of slight weight gain and light bleeding.
 ...
PMID:Adolescents and Norplant: preliminary findings of side effects. 766 87

Clinicians examined the family planning decisions of 3938 women who underwent prenatal diagnosis (ultrasonography, amniocentesis, or chorionic villus sampling) at the Division of Reproductive Genetics at the University of Tennessee in Memphis between January 1988 and May 1993. 104 women were carrying fetuses with chromosome abnormalities, of whom 92 opted to terminate their pregnancies. 57 women were carrying fetuses with neural tube defects, of whom 49 chose to end their pregnancies. Among the 91 fetal chromosome abnormality cases with complete information on family planning decisions, 84 had autosomal abnormalities and 7 had sex chromosome abnormalities. Among the 41 fetal neural tube defect cases with complete information on family planning decisions, 22 had spina bifida and 19 had anencephaly. The mean age of women with a chromosome abnormality fetus was higher than that of those with a neural tube defect fetus (36.8 vs. 27.3 years; p 0.03). Just 20 women (15.2%) chose permanent sterilization after continuing or terminating the affected pregnancy. Women carrying fetuses with chromosome abnormalities were more likely to choose permanent sterilization than those carrying fetuses with neural tube defects (18.7% vs. 7.3%; p 0.03). Advanced maternal age was associated with the decision to undergo permanent sterilization (p 0.04). Physicians should counsel women who have opted to terminate a pregnancy of an abnormal fetus to delay any decision to undergo permanent sterilization to allow for resolution of grief and depression. They should advise the women to use safe, reliable, and long term reversible contraceptive agents (e.g., Norplant subdermal implant system, the injectable Depo-Provera, IUDs, and oral contraceptives).
 ...
PMID:Family planning decisions after prenatal detection of fetal abnormalities. 797 49

Between October 1986 and November 1988, physicians enrolled 267 20-41 year old women in a clinical trial of Norplant-2 (2 Silastic rods with 70 mg levonorgestrel each) at the National Taiwan University Hospital to evaluate the advantages and side effects of Norplant-2. 36 women were lost to follow up. 63% suffered from menstrual problems during the first 3 months. 73.6% of these women still had menstrual problems at 6 months. 6 women then chose to discontinue using Norplant-2. 51.8% of the remaining women had persistent menstrual problems at 1 year. 62% of women who discontinued Norplant-2 before the end of 3 years discontinued it due to menstrual problems. The continuation rate was 84.5% at 1 year, 61.3% at 2 years, and 52% at 3 years. 78.6% of women who discontinued Norplant-2 to become pregnant conceived within 1 year after its removal. Just 1 woman (.04%) became pregnant while using Norplant-2. She was thin and smoked heavily. Her aborted fetus had an abnormal fetus had an abnormal karyotype (47,XY,+22). The mean serum total cholesterol and triglyceride levels dropped considerably after Norplant-2 implantation from 164 to 147 mg/dl and from 81 to 63 mg/dl at 12 months, respectively; p .05). Mean hemoglobin levels increased from 12.6 g/dl to 13 g/dl at 12 months (p .05). Levonorgestrel did not affect liver or renal functions. Mean body weight and blood pressure remained the same. Observed psychophysiologic symptoms included depression, acne, headaches, nervousness, and insomnia. These findings indicated Norplant-2 to be safe, reversible, long-acting, and very effective, therefore the family planning program in Taiwan should add it to its contraceptive menu.
 ...
PMID:Norplant-2 subdermal contraceptive system: experience in Taiwan. 810 98

During July 1991-July 1993 in Edinburgh, Scotland, 508 women 15-42 years old were inserted with the contraceptive subdermal implant Norplant. Physicians and trained family planning nurses counseled the women, which counseling included a detailed description of Norplant, its advantages and disadvantages (especially bleeding problems), and a description of the insertion and removal procedures. The women chose Norplant as an alternative to sterilization or other contraceptive methods with which they experienced problems. Two women were pregnant at the time of insertion. There were no method failures. 27 (9%) women were lost to follow-up. 71 (25%) women were very satisfied with Norplant, 30 of whom had regular cycles and 14 of whom had amenorrhea. At least 70% of all patients experienced changes in vaginal bleeding patterns. The 12-month and 18-month continuation rates were 84% and 80%, respectively. Leading reasons for removal of Norplant were bleeding problems (43%), weight gain (35%), and mood swings (21%). The combination of weight gain, mood swings, depression, and headache accounted for 56% of all removals. Major problems did not occur with either insertion or removal of Norplant. These findings suggest that Norplant is an effective and acceptable contraceptive method, despite the high incidence of bleeding changes.
 ...
PMID:The introduction of a new contraceptive; two years experience with Norplant. 878 85

A retrospective study of 144 US women 14-21 years of age who requested and received the Norplant contraceptive implant system at the Mayo Clinic (Rochester, Minnesota) in 1990-93 analyzed the factors associated with duration of method use. Of the 124 women who reported past use of contraception, 94 (76%) had been pregnant at least once. The method most commonly used before Norplant was oral contraception (57%). The reasons for Norplant selection were its convenience (86%) and problems tolerating the pill (14%). Of the 130 Norplant users who either telephoned or made a clinic appointment after insertion, 60% reported side effects such as breakthrough bleeding, headache, and depression or mood swings. 64 women had the implants removed. The median duration of Norplant use was 29 months. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83% and 63% for at least 24 months. Age, prior contraceptive use, and timing of insertion had no impact on duration of Norplant use. Multivariate analysis indicated that women with at least 1 prior pregnancy had a two-fold increased risk of Norplant removal compared to those who had never been pregnant. Larger studies are needed to identify additional factors associated with long-term use of injectable contraception among young women and to suggest interventions that would improve compliance with routine follow-up.
 ...
PMID:Levonorgestrel contraceptive implants in female patients 14 to 21 years old. 944 73

Although depression is cited in the Norplant contraceptive implant product labeling as a rare side effect, previous evaluations of this association have not included baseline measurement of mood. To assess this association more systematically, the present study followed a cohort of 910 new Norplant acceptors recruited from three urban hospitals in the US (Texas, Pennsylvania, New York) for 24 months. Included in both the initial and follow-up questionnaires were six questions drawn from the Mental Health Inventory on depressive symptoms in the past month. At the end of the study period, 293 women were still using Norplant, 295 had discontinued use, and 138 were lost to follow-up. Women who continued with Norplant for 2 years had significantly lower depression scores at baseline than women who discontinued use or were lost to follow-up. Among continuing Norplant users, mean depressive symptom scores were similar before starting Norplant and after 6 months of use (7.9 and 7.7, respectively). The strongest overall predictor of the depression score was relationship satisfaction. At 24 months, the subgroup of continuing users with decreased relationship satisfaction had an increase in depression score, while those with no change or improved relationships had stable scores. The mean depression score of the quintile of women most depressed at enrollment improved during the study period from 15.4 to 11.0, dispelling concerns that Norplant exacerbates pre-existing depression. Only 4.4% of discontinuers cited mood changes as a reason for terminating Norplant use and there were no cases of psychiatric hospitalization. These findings suggest that concern about possible mood changes is not a reason to withhold Norplant.
 ...
PMID:Depressive symptoms and Norplant contraceptive implants. 964 15

The Indian government's plan to introduce the new long-acting contraceptive Norplant in the National Family Planning Program under pressure from the US government is opposed because Norplant has not been adequately tested. The government has reduced the funding for the national program for eradication of malaria and tuberculosis, but it is proposing to finance a Norplant based population project for the State of Uttar Pradesh. The powers that can turn a deaf ear to the possible hazards of Norplant. Implanted in the arm of a woman, the chemical is released into the bloodstream providing contraception for 5 years. Severe adverse reactions include depression, heart disease thromboembolism, high blood pressure, and ovarian cysts. Many such long-acting contraceptives are being developed including injectables, vaccines, nasal sprays, and vaginal rings with potential permanent impairment to fertility. One of the major objectives of the Family Planning Program is the improvement of the health status of women, but the introduction of Norplant would harm healthy young women. Therefore, the group Saheli and others in the campaign demand: 1) that plans for introduction of Norplant in the Family Planning Program be halted immediately; 2) that the introduction of any other long acting invasive contraceptive such as Net-En, vaginal ring, nasal spray, and anti-fertility vaccine be banned, both on the grounds of inadequacy of the health services and loss of user controls; 3) that information on the safety aspects of Norplant and the basis on which the Drugs Controller has granted his approval be made public; 4) that each and every one of the hundreds of women who still have the implant should be located, and the implant removed; and 5) that all hormonal contraceptive preparations be banned in the social marketing program as their use involves extensive monitoring.
 ...
PMID:Norplant campaign in India. 1228 26


1 2 Next >>