Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Compilation of recent data on 1130 female volunteers from 17 US sites enrolled in a study of a new low dose combination oral contraceptive (OC) containing .15 mg levonorgestrel and .03 mg ethinyl estradiol are reported. All clients had complete histories and physical examinations at entrance and at 6 month intervals during treatment, and about 20% also had blood sugar, blood urea nitrogen, and liver profile determinations. Follow-up evaluation was performed after the 1st and 3rd cycles and every 3 cycles thereafter to determine patterns of pill taking, bleeding episodes, untoward effects, and concomitant medication. Clients ranged in age from 15-40 with mean age of 23.6; 76.1% were white, 11.9% black, 7.5% Hispanic, and 4.4% Oriental. 61.9% were of proven fertility and 92% had regular cycles. 48.1% of the study population had not used female hormones or been pregnant within 60 days of enrollment. A total of 11,064 cycles over a maximum 31 cycles of treatment are reported. Despite 1-6 or more missed pills in 1623, or 14.7% of the cycles, only 3 pregnancies were reported, only 1 presumed to be a method failure, for a use-effectiveness Pearl index of .35/100 women years of usage. Use of the formulation resulted in a mean cycle length of 28.5 days. 92.7% of cycles ranged from 26-30 days, almost equal to pretreatment values. The frequency of light menstrual flows increased. Breakthrough bleeding was reported in 669 cycles, or 6.0%, while spotting occurred in 852 cycles, or 7.7%. Amenorrhea was reported after 194 cycles (1.8%). No reports of post-pill amenorrhea were made. Incidence of side effects was very low. Only acne, breast discomfort, dysmenorrhea, gastrointestinal symptoms, headache, nausea, and vaginal discharge were reported in more than 1.0% of cycles. The pill had essentially no effect on weight or blood pressure, and produced no clinically significant laboratory abnormalities in hematology, urine, blood sugar, blood urea nitrogen, or liver profile determination. A total of 515 subjects (45.6%) discontinued use of the drug for various nonmedical reasons. Another 146 women (12.9%) discontinued use and gave medical reasons; 132, or 11.7%, were commonly reported side effects of OCs such as breakthrough bleeding, headache, and nausea. Clinical trials with the formulation have shown it to be a safe and effective ultra-low dose combined OC agent whose mode of action is primarily gonadotropin suppression and subsequent anovulation.
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PMID:A new ultra-low-dose combination oral contraceptive. 640 5

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

RU 486, a new antiprogestational compound, was given to 37 women seeking termination of pregnancy and with amenorrhea of 42 days or less. 1 patient was found at the 2nd follow-up visit to have an extrauterine pregnancy. The patients received either 25 mg, 50 mg, or 100 mg RU 486 twice daily for 4 days. All patients attended 3 follow-up visits, 1, 2, and 5-6 weeks after the start of therapy. The start, duration, and amount of bleeding as well as plasma progesterone, beta-human chorionic gonadotropin (hCG) and cortisol concentrations were determined for each treatment day and at follow-up visits. All but 3 patients started to bleed during treatment. Frequency of complete abortion was 61% (22 of 36 patients). In only 3 patients was the pregnancy unaffected by treatment. The clinical efficacy of the treatment was not dose-dependent. Most of the patients experienced only minor dise effects in terms of mild uterine pain, nausea, and vomiting. However, 2 patients suffered from heavy bleeding requiring blood transfusion and curettage. In patients with complete abortion, beta-hCG values decreased significantly but not until the 1ft follow-up visit. The plasma progesterone also decreased. This decrease appeared earlier with the higher daily dose of RU 486. Cortisol concentrations increased during treatment with all 3 dosage regimens but the levels remained within the normal range. It is concluded the treatment with RU 486 may provide a novel therapy for menstrual regulation but the efficacy of it needs to be improved to compete with such alternatives as vacuum aspiration.
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PMID:Termination of very early pregnancy by RU 486--an antiprogestational compound. 674 60

Cervical priming with the aid of a single 15-ME-PGF2a vaginal suppository prior to IUD insertion resulted in cervical changes which facilitated the procedure. A 0.5 mg 15(S)-15-prostaglandin F2a methyl ester vaginal suppository was administered one hour prior to the IUD insertion in all patients studied. The insertion was performed in all patients studied. The insertion was performed from seven to seventeen days following the LMP with the exception of four patients with prolonged amenorrhea. A mean increase in cervical dilatation of 2.14 mm was achieved with minimal side effects. The cervical ripening and dilatation produced by the suppository increased the ease of IUD insertion , and expanded the time frame in which an IUD insertion could be performed. The method was well tolerated by all patients and eliminated the nausea and syncope often associated with IUD insertion.
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PMID:A new iud insertion technique utilizing cervical priming with prostaglandin. 712 35

A discussion of the side effects of hormonal oral contraceptive (OC) use is presented. Studies show that the estrogen component of OCs works to suppress the release of GRH (gonadotropin-releasing hormone), reducing the serum FSH level. The gestagen component desensitizes the frontal lobe of the pituitary gland to the effect of GRH and suppresses the preovulatory LH peak. OCs can cause subjective side effects such as nausea, headache, depression, which can also be observed during placebo use. Breakthrough bleeding, spotting, silent menstruation, and post-pill amenorrhea are menstrual irregularities which can be linked to OC use; 98% of those who discontinue OC use show normal biphasic menstrual cycles 3 cycles after discontinuation. A constant increase in serum triglyceride levels, small increases in cholesterol and phospholipid levels are observed among OC users. Minor cases of hyperinsulinism are observed among OC users with no history of diabetes; glucose tolerance tests should be regularly administered to OC users who have a risk of diabetes or a history of pregnancy diabetes. Serum levels of proteins are affected by OC use, probably due to the effects of OC use on liver function. Studies have shown an increased risk of thromboembolism and circulatory disorders among OC users, especially those who are over 30 years of age or who smoke. OC use has been linked to development of benign tumors of the liver and the cervix. Gestagens appear to reduce the frequency of endometrial mitosis. Other medications, e.g. analgesics, barbituates, can reduce the effectiveness of OCs. For adolescents, sequence preparations are preferred and should be administered only after a 1 year period of regular menstruation. Thorough check-ups should be performed on OC users twice yearly, and contraindications should be scrupulously observed.
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PMID:[Effects and side effects of hormonal contraceptives]. 741 48

To address the issues of poor oral contraceptive (OC) compliance and early OC discontinuation, OC use was analyzed in a convenience sample of 6676 women between the ages of 16 and 30 from Denmark, France, Italy, Portugal, and the United Kingdom, obtained from the Wyeth-Ayerst Contraceptive survey conducted in 1993. Logistic regression was used to examine the independent effect of each factor. 81% of the women used their OCs consistently. User characteristics accounted for inconsistent use. Poor compliance was associated with a lack of established routine for pill-taking and failure to read and understand written materials that came with the OC package. Those who understood little or none of the instructions were 2.4 times more likely to be among women who missed 2 or more pills per cycle. Other factors for inconsistent use included not receiving adequate information or help about OCs from their health care provider (RR = 1.5), and occurrence of certain side effects, including hirsutism (RR = 2.1), nausea (RR = 1.4), bleeding irregularities such as breakthrough bleeding and amenorrhea (RR = 1.3), and breast tenderness (RR = 1.2). Women who were inconsistent OC users, missing 1 or more pills per cycle, were 2.6 times as likely to experience an unintended pregnancy while using OCs than were women who took their OCs consistently. Factors that predicted early discontinuation (women who wished to continue contraceptive protection but discontinued OC use) were primarily side effects, including nausea (RR = 2.1), bleeding in the first 3 months (RR = 1.9), breast tenderness (RR = 1.8), mood changes (RR = 1.8), hair growth (RR = 1.7), and weight gain (RR = 1.4). Multiple side effects substantially increased the likelihood of discontinuation, with a single side effect increasing the risk by 50%, 2 by 220%, and 3 by 320%. Improved compliance can be facilitated if providers emphasize the need to continue to take OCs reliably even if side effects do occur.
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PMID:Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. 762 1

Cabergoline is a synthetic ergoline which shows high specificity and affinity for the dopamine D2 receptor. It is a potent and very long-acting inhibitor of prolactin secretion. Prolactin-lowering effects occur rapidly and, after a single dose, were evident at the end of follow up (21 days) in puerperal women, and up to 14 days in patients with hyperprolactinaemia. In the only comparative study to date, cabergoline 0.5 to 1.0 mg twice weekly was more effective than bromocriptine 2.5 to 5.0 mg twice daily in the treatment of hyperprolactinaemic amenorrhoea, restoring ovulatory cycles in 72% of women and normalising plasma prolactin levels in 83%, compared with 52 and 58%, respectively, for bromocriptine. In the prevention of puerperal lactation, a single dose of cabergoline 1.0mg was as effective as bromocriptine 2.5mg twice daily for 14 days. A significantly lower incidence of rebound lactation in the third postpartum week was seen with cabergoline. Unpublished data suggest cabergoline 0.25mg twice daily for 2 days is effective in suppressing established puerperal lactation in about 85% of women. Nausea, vomiting, headache and dizziness are characteristic adverse events of the dopaminergic ergot derivatives. Cabergoline appears to be better tolerated than bromocriptine in both patients with hyperprolactinaemia and postpartum women. Most patients intolerant of other ergot derivatives can tolerate cabergoline. Bromocriptine use in the puerperium has been associated with an increased risk of serious thromboembolic events. However, there are no such reports with cabergoline and whether these events will become associated with other dopaminergic agents is unknown. The teratogenic potential of cabergoline has not been extensively investigated in humans. Ten congenital abnormalities have been reported in 199 cabergoline-associated pregnancies. Although there is no pattern to these abnormalities, the limited experience with cabergoline in pregnancy means the drug cannot be considered as a first-line therapy for the treatment of infertility associated with hyperprolactinaemia. At this stage of its development, cabergoline will prove useful in patients with hyperprolactinaemia who have failed treatment with, or are intolerant of, other dopamine agonists such as bromocriptine. If drug treatment is required for the prevention or suppression of puerperal lactation, cabergoline offers significant advantages over bromocriptine and should become the drug treatment of first choice for this indication.
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PMID:Cabergoline. A review of its pharmacological properties and therapeutic potential in the treatment of hyperprolactinaemia and inhibition of lactation. 772 32

The objective of the study was to assess the clinical effectiveness of the monophasic oral contraceptive Marvelon by examining its safety and its effectiveness in controlling the menstrual cycle as well as the frequency and types of side effects. 24 healthy women with an average age of 24.5 years (range of 18-33 years) were the subjects. 23 had previous reproductive events: 18 births, 5 spontaneous abortions, and 16 induced abortions. 17 women had used contraceptives sporadically: 3 postcoital pills, 8 triphasic pills, and 6 monophasic pills. During the year prior to initiating Marvelon use 2 women had experienced oligomenorrhea, 5 had had hypermenorrhea, 6 had had dysmenorrhea, and 3 had had irregular uterine bleeding. The observation period of contraceptive use lasted 4-6 months, during which a total of 121 cycles were evaluated without one single case of pregnancy. This meant a 100% contraceptive safety or a Pearl index of 0. 20 of the patients had stable cycles. 4 women with 13 of the 121 cycles (10.5%) had menstrual disorders. There were 5 cases of breakthrough bleeding and 8 cases of spotting. Weak dysmenorrhea occurred only in 2 patients. Other side effects included: nausea (2), headache (2), nervousness (2), mastodynia (3), vertigo (1), depression (1), and increase of body weight (2). As the duration of taking Marvelon increased the frequency of menstrual disorders declined. Not a single case of post-pill amenorrhea occurred. At the present time over 5 million women use Marvelon in the world. Epidemiological studies involving 14,903 women with a total of 98,225 menstrual cycles have revealed only 4 pregnancies or a Pearl index of 0.06. In the present study regular pseudomenstrual bleeding was confirmed in 89.5% of investigated cycles, which compares to 96.1% indicated in the literature. Marvelon proved to be a modern, safe contraceptive with stable control of the menstrual cycle, and which exhibited only minor side effects.
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PMID:[A clinical trial with the monophasic contraceptive Marvelon]. 779 30

The synthesis of mifepristone (RU-486) in 1980 was a major step in the development of a simple, safe, and effective method for abortion that women can use themselves. RU-486 ends pregnancies by blocking the action of circulating progesterone at its receptor. Hormones must be able to fit into their uniquely-shaped receptors in order for the necessary series of biological events to occur. RU-486 is shaped very much like the progesterone molecule with 2 important changes: a very long side chain which permits it to bind tightly to progesterone receptors and a bulky side chain which makes it inactive as a progestin. A large dose of RU-486 saturates the progesterone receptors in the uterus and prevents progesterone from playing its sustaining role in the pregnancy. RU-486 also increases the production of prostaglandins (which stimulate uterine contraction) and the sensitivity of the uterus to prostaglandins. Early studies on the use of RU-486 for first-trimester abortions concentrated on finding the best dose and circumstances to increase the abortion rate. In 1985, Swedish investigators developed a procedure which capitalized on the drug's ability to enhance sensitivity to prostaglandins. After RU-486 establishes sensitivity, the abortion rate is improved by administration of the prostaglandin gemeprost as a vaginal suppository in doses a fraction of those necessary to induce abortion. This combination is currently used in France, the UK, and Sweden. In France the gestational age limit is 49 days of amenorrhea, in the UK and Sweden it is 63 days. This procedure involves an initial administration of RU-496 with a follow-up visit in 2 days. If the woman has not aborted, she is given a dose of prostaglandin and observed for about 4 hours, during which time most women abort. A return visit is scheduled in 2 weeks. The efficacy of this method has been measured at 94-96%. The procedure has recently been improved by the use of an oral pill, misoprostol, as the prostaglandin. RU-486 has also been used successfully to prepare cervixes for mechanical dilation, although a pretreatment interval of 36-48 hours is necessary. Second-trimester induction-of-labor abortion time and required doses of prostaglandins are also reduced with RU-486, making the procedure a less expensive, more comfortable, outpatient process. RU-486 has also shown promise as an emergency (postcoital) contraceptive, with 2 trials in the UK resulting in no pregnancies and fewer women experiencing nausea or vomiting. The work that remains to be done to improve the use of RU-486 in early abortions involves establishing the correct dosage and simplifying the provision of service without compromising safety to insure that women living in remote areas will have access to the procedure.
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PMID:Mifepristone (RU 486) for induced abortion. 827 73

Breakthrough bleeding as a side effect of oral contraceptive (OC) use is considered one of the primary causes if discontinuation of oral contraceptives. In this study, the incidence and pattern of vaginal bleeding is examined and correlated with biologic responses and plasma steroid bioavailability. Between October 1, 1985 and October 15, 1987, subjects were randomly selected from eligible women beginning OC use as patients of the Department of Gynecology and Obstetrics at the Johns Hopkins Medical Institutions. Women were grouped by type of OC as follows: 1) 67 women taking 50 micrograms of ethinyl estradiol and 1.0 mg of norethindrone (OC1);l 2) 61 women taking 35 micrograms of ethinyl estradiol and 1.0 mg of norethindrone (OC2); and 3) 64 women taking 35 micrograms of ethinyl estradiol and .5 mg of norethindrone (OC3). Estrogen and progesterone concentrations in plasma were measured on the 21st day during the third, sixth, and ninth cycles. The samples was taken 24 hours after ingestion of the pill for day 20, and 1 hour after taking the pill on day 21. An extensive interview was also conducted for all study participants. Bleeding was recorded for any amount of bleeding occurring during days 2 through 21, and during days 21 through 28. Cycles were omitted where pills had been forgotten by the patient. An initial slope was calculated with the 1 hour value level and subtracting the 0 hour level over the actual time interval. Linear regression analysis was used to compare the slopes and bleeding days. Of the 316 women enrolled, 61% (192) completed the study. The findings were that the incidence of intermenstrual bleeding was not statistically different among the various preparations. For 59 patients eliminated from the study, 24% experienced intermenstrual bleeding. Those lose to follow-up were not among those unwilling to tolerate their bleeding pattern. There was similar incidence of other side effects among all three preparations: .5% amenorrhea of dysmenorrhea, 7% nausea, 16% headache, 26.5% depressed mood, 16.6% breast tenderness, and 44.3% acne. The low-dose OC3 had the statistically highest rates of intermenstrual bleeding. The bleeding patterns are described. Bleeding patterns were higher than those previously reported in the literature. Further research might focus on controlling for factors such as hormone-binding globulin capacity.
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PMID:A randomized trial of three oral contraceptives: comparison of bleeding patterns by contraceptive types and steroid levels. 831 16


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