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Query: UMLS:C0018681 (headache)
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NORPLANT progestogen-only implant contraception provides several years of effective protection against pregnancy following a single application. It is reversible whenever desired, with return to normal fertility. Drug release and concentrations are maximal in the first month of use, when a set of six capsules releases approximately 85 micrograms/day of levonorgestrel. Release is 25-30 micrograms/day at 60 months. Circulating drug concentrations and pregnancy rates vary inversely with body weight at placement, but even among heavier women, failure rates are below those of oral contraceptives in the general population. Side-effects are most marked at the initiation of use. Disruption of normal menstrual patterns occurs in 70-80% of recipients initially. Menstrual blood loss is decreased, however, and most women experience modest increases in haemoglobin. Headache, acne, other skin or hair problems, changes of weight and of mood and abdominal pain, are the most common side-effects attributed to NORPLANT contraception. The frequency of occurrence of side-effects diminishes with increased duration of use. The comparative paucity of major side-effects, coupled with the method's convenience and effectiveness and its very long action have made NORPLANT implants highly acceptable in both developing and developed countries.
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PMID:Contraception with NORPLANT implants. 784 9

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.
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PMID:Norplant-2 subdermal contraceptive system: experience in Taiwan. 810 98

The data for this analysis were obtained from the records of the Bulgarian Association for Family Planning (BAFP); the data covered a period of 3 years and were for 593 women with a total menstrual cycle of 3132. The most frequently used monophasic oral contraceptives were Cilest (containing norgestimate and ethinyl estradiol), used by 233 women, Marvelon (containing desogestrel and ethinyl estradiol), used by 154 women, Microgynon FE, used by 117 women, and Nordette (containing levonorgestrel and ethinyl estradiol), used by 89 women. The preparations were used mainly for contraception, but some women used them for menstrual regulation (27 women used Nordette for this purpose and so did 25 women use Marvelon for such a purpose), and a small percentage of the women used them for used dysmenorrhea. 103 (43.2%) women who used Cilest were in the 14-19 age group, while 106 (45.4%) of them were in the 20-25 age group. In the 14-19 age group 20 (17.2%) used Microgynon, 18 (20.2%) used Nordette, and 60 (38.8%) relied on Marvelon. In the 20-25 age group the respective figures were 79 (67.2%) for Microgynon, 40 (44.9%) for Nordette, and 67 (42.5%) for Marvelon. Some of the unfavorable metabolic effects of oral contraceptives included the increase of LDL and the reduction of HDL levels and androgenic effects. The most frequent side effect was intermenstrual bleeding, of which there were 19 cases for Cilest, 7 for Microgynon, 5 for Nordette, and 11 for Marvelon. Menstruation was prolonged in 4 women using Cilest and in 5 using Marvelon. 5 women using Cilest, 2 using Microgynon, and 2 using Nordette had headache. Other adverse effects included episodes of galactorrhea, discomfort, mastopathy, and bloating in the stomach. These effects did not pose a risk to general or reproductive health and did not justify discontinuation of use for these preparations.
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PMID:[Current monophasic hormonal contraception]. 985 26

(1) Mirena degrees is a contraceptive intrauterine device delivering levonorgestrel. (2) Its assessment is based on two prospective randomised multicenter trials comparing it to a copper device. (3) It is not known whether it is any more difficult to insert than other devices. (4) Efficacy, in terms of absolute protection and risk of extrauterine pregnancy, appears to be very good, at least equal to that of copper devices. (5) Women were less subject to menorrhagia than were women using a copper device. (6) In clinical trials up to a third of women had amenorrhoea. Some women had spotting during the first three months, and other adverse effects (e.g. acne, headache and mastodynia) were more frequent than among women using copper devices.
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PMID:Levonorgestrel intrauterine device: new preparation. An alternative. 1150 15

Progestin only birth control pills appeared on the US market in 1973. As there is no estrogen in these mini pills, they may have fewer dangerous side effects than the combined pills. Some clinics suggest mini pills for women who suffer from estrogen excess side effects. The 3 mini pills available in the U.S. are called Micronor, NOR-QD, and Ovrette. Instructions are presented for patients who are interested in using mini pills. The mini pills most likely work by affecting a women's fertility in several ways: act as a messenger to the woman's ovaries and uterus to prevent the release of an egg; thicken the mucous on the cervix, making it difficult for the sperm to "get through" the cervix and reach the egg; and change the lining of the uterus so that it may not develop properly for the fertilized egg to grow. The mini pills can be 97% effective is used perfectly. The mini pills are only effective for as long as a woman takes them. A woman must take a pill every day to prevent pregnancy. A woman should not use the mini pill if she has or ever has had any of these problems: blood clotting problems in veins; stroke; cancer of the breast or reproductive parts of the body; suspected pregnancy, current pregnancy; and undiagnosed, abnormal genital bleeding. Possible benefits for a woman using mini pills include: an effective method of birth control; a method for nursing mothers since it does not seem to affect the amount of their breast milk; and a possible reduction in premenstrual cramps. Possible risks for a woman using mini pills include: irregular periods; and a less effective method if the patient does not take a pill every day. The danger signals to look for are abdominal pain, chest pain, headaches, eye problems, and severe leg pain. A patient should revisit a clinic in the following situations: has not had a period within 45 days of the last period; severe abdominal pains while taking mini pills; experiences a warning signal; any time one thinks the pills are causing trouble; and once a year for a pap smear, breast examination, and laboratory tests.
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PMID:How to use mini-pills: helpful patient instructions. 1226 79

A study of 2 low-dose oral contraceptives, Loestrin and Nordette, was conducted in association with the National Family Planning Board in Kota Bharu, Kelantan, West Malaysia, to determine differences in continuation rates and reasons for discontinuation. This report includes analysis of 96 women, 91.7% of whom were interval patients, randomly allocated to 1 of the above OCs between December 1979 and January 1981. Follow-up visits were scheduled at 1, 3 and 6 months after admission with symptom grids completed during the 1st, 3rd, and 6th cycles. The continuation rates at 6 months were 85.9 and 89.8 for Loestrin and Nordette, respectively. The corresponding follow-up rates were 73.9 and 68.3. The side effect reported most often among both groups was breakthrough bleeding (BTB). In addition, the proportion of Loestrin users who reported BTB at least once during the study was significantly higher than the proportion of Nordette users (38.3% versus 18.4%, p 0.05). Other symptoms reported were nausea, headaches, intestinal problems, and abdominal pain. No accidental pregancies were reported during this study. There were a total of 6 (11.8%) discontinuations in the Loestrin group and 4 (8.9%) in the Nordette group.
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PMID:A comparative study of Loestrin versus Nordette in Kelantan, West Malaysia. 1226 18

Results of a large multicentered clinical trial of a new contraceptive vaginal ring show that the new ring may be about as effective as oral contraceptives but with fewer side effects. The ring, which is a little smaller than a 75 mm diaphragm and has a Silastic inner core and outer tubing, is avilable in 2 sizes (50 mm or 58 mm) and contains a middle layer with a steroid mixture of estrogen and progestin. Both types of ring contain about 100 mg levonorgestrel and 50 mg estradiol. Ovulation is suppressed by the steroids in the ring. The ring is placed in the vagina for about 3 weeks and then removed for 1 week. Withdrawal bleeding occurs when the ring is removed. Comparative studies of the effectiveness of the ring and a pill (Nordette, which contains 150 mcg levonorgestrel and 30 mcg estradiol) show that after a year's use, both type of contraceptives had a pregnancy rate of about 3 pregnancies per 100 users. Ring users had higher continuation rates than pill users (50/100 women for the ring vs. 30/100 for the pill). Reasons for discontinuation for the ring include occurrence of vaginal discharge, vaginitis, and menstrual problems. Ring users had lesser incidence of nausea and headache compared to pill users; they also did not experience an increase in angiotensinogen levels or blood pressure. Another advantage of the ring is its once-a-month administration. Investigators are still testing the best method for using the ring. However, as testing is not yet complete, application for approval by the Food and Drug Administration may take quite some time.
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PMID:Trials point to effectiveness of new vaginal ring. 1227 58

The acceptability and effectiveness of a progestogen-only oral contraceptive (OC), Ovrette, during lactation were investigated in 200 women recruited from a teaching hospital in Khartoum, Sudan. Ovrette contained 0.075 mg of norgestrel. 69 women (34.5%) had used OCs at some point prior to the index pregnancy. Serious complications (e.g., severe headache, chest pain, leg pain, abdominal pain, blurred vision) were reported by 8 respondents during the 12-month study period. Less serious side effects included dysmenorrhea (49 women), nausea (28 women), dizziness (38 women), vaginal discharge (86 women), headaches (78 women), and breast discomfort (21 women). Overall, 143 women (71.5%) experienced at least 1 side effect. Of the 21 women (10.5%) who discontinued Ovrette use before 12 months, 9 were motivated by menstrual problems and other side effects. The 12-month continuation rate was 89.1%. There were 2 pregnancies, only 1 of which represented method failure. These findings are consistent with previous studies indicating that use of progestin contraceptive agents is associated with more menstrual disturbances and pregnancies than combined OCs. Use of combined OCs is contraindicated during lactation, however.
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PMID:A study of a progestogen only oral contraceptive for lactating women in Khartoum, Sudan. 1229 69

Wyeth-Ayerst Laboratories recently introduced Alesse, a 20 mcg monophasic oral contraceptive pill available in 21- and 28-day regimens. The pill is comprised of 20 mcg of ethinyl estradiol and 100 mcg of levonorgestrel. Alesse was recently cleared for release by the US Food and Drug Administration (USFDA). A multicenter clinical trial involving 1477 women aged 17-49 years found the pill to provide good cycle control. Headache was the most common side effect noted by women in the trial. The only other 20 mcg pill, Loestrin 1/20, manufactured by Parke-Davis, also uses ethinyl estradiol for its estrogen, but 1 mg of norethindrone acetate as its progestin. The availability of such low-dose pills is particularly important for women in their later contraceptive years. These women may need contraception as well as relief from perimenopausal symptoms. The USFDA also cleared Alesse for use as an emergency contraceptive pill, the seventh brand approved by the agency for such use.
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PMID:Wyeth-Ayerst introduces Alesse; OC expands range of low-dose pills. 1229 28

Another low-dose oral contraceptive (OC), Levlite, has received US Food and Drug Administration approval. Levlite, manufactured by Berlex Laboratories, contains 20 mcg ethinyl estradiol and 100 mcg levonorgestrel. Alesse, an OC manufactured by Wyeth-Ayerst, has the same components. Two other OCs--Loestrin and Mircette--contain 20 mcg ethinyl estradiol, but differ in their progestin component or dose. A pill containing 20 mcg ethinyl estradiol provides women with 33% less estrogen than a 30-mcg pill. Clinical trials involving 755 US women confirmed that Levlite provides high contraceptive efficacy with good cycle control. Headache, reported by 17.3% of study participants, was the most common side effect.
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PMID:Berlex introduces new 20 mcg birth control pill. 1229 11


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