Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study of utilization of 2 combined minipill preparations by 295 women over 12-18 months is intended to aid the general practitioner in prescribing an easily tolerated oral contraceptive. 152 patients were given Minidril (21 pills containing 30 mcg Ethinyl Estradiol (EE) and 150 mcg of levonorgestrel (LNG)), while 143 were given Adepal (7 pills containing 30 mcg EE and 150 mcg LNG and 14 containing 40 mcg EE and 200 mcg LNG). 2/3 receiving either prescription were between 20-30 years. 56% of Minidril and 50% of Adepal users had no children, 15% of Minidril and 20% of Adepal users had 1 child, and 17% of Minidril and 16% of Adepal users had a history of prior induced abortion. Minidril and Adepal respectively were prescribed in 51 and 32 cases as the first OC, after abortion in 22 and 12 cases, and after side effects with higher dose combined pills in 33 and 94 cases. Minidril was prescribed following use of Adepal in 39 cases, and Minidril and Adepal were prescribed following use of Stediril in 7 and 5 cases respectively. Adepal is useful in cases of weight gain, migraines, lipid intolerance, recurring candida infection, breakthrough bleeding, benign breast disease, and occasionally for frigidity. No pregnancies occurred with either pill, and tolerance was excellent. 3 secondary effects encountered in about 375 woman-years of Adepal use required discontinuation: 1 case of rapid increase in ovarian size, 1 case of hypertriglyceridemia, and 1 case of persistent breast pain, which disappeared after cessation of treatment. Breast discomfort in 12 cases disappeared after several months' use.
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PMID:[Minidril and Adepal. 2 minidose pills: an easy prescription for the doctor, without incidents or risks for the woman]. 1231 40

A comparative cohort study on the insertion of Norplant by midwives and physicians had been carried out to compare its safety. A total of 500 acceptors participated in the study, 292 of whom belonged to the group of midwives and 202 to the physicians group. They came from suburban areas surrounding the city of Yogyakarta, Indonesia. Although both groups were statistically different in terms of age and body weight, they were not so clinically. Norplant was delivered outside the hospital during the mass campaign (safari susuk), but standardized hospital asepsis was taken. Follow-up was done 1 week thereafter to detect the presence of complications or side effects, such as pain, inflammation, abscess and sense of itching. The statistical analyses used in this study were the t-test, chi-square test, and relative risk. Results showed that midwives inserted Norplant more rapidly compared to physicians (2.36 vs. 3.45 minutes, respectively), although it did not have clinical importance. 23.6% of the cases among the midwife group showed a variety of complications while that of the physician group was 19.7%, the relative risk being 1.20 (0.82-1.75). More detailed complications such as pain, inflammation, abscess, and itching did not show significant difference. The risk of complication in all cases was influenced by neither the duration of insertion nor by the level of education. The study concluded that midwives could insert Norplant as safely as physicians.
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PMID:[Insertion of Norplant by midwives and physicians: comparative cohort study]. 1231 76

The intrauterine contraceptive device (IUD) is effective and reversible and has a high continuation rate. It can also be used within 7 days postcoitus. Developed separately by Richter, Grafenberg, and Ota between 1909 and 1934, the IUD gained popularity in the 1960s and 1970s with the introduction of the Margulies Spiral, the Lippes Loop, the Birnberg Bow, and the Dalkon Shield. The last proved dangerous, and the IUD became unpopular. The 4 IUDs which are available in Canada include the TCu-380S (GYNE T Slimline), the TCu-200, the NOVA-T, and the Progestasert. All are T shaped and medicated (copper or progesterone). The 1st and 3rd can be left in situ for 10 years; the 2nd, for 4 years; and the 4th, for 1 year. The NOVA-T has a copper wire with a silver core and is inserted with a unique pull-push technique. The Progestasert, which contains 38 mg of progesterone, releases 65 mcg of the hormone daily. The best candidate for IUD use is parous, but not pregnant, is in a stable monogamous relationship, and has a healthy reproductive tract and no history of ectopic pregnancy, sexually transmitted disease, pelvic inflammatory disease, undiagnosed genital bleeding, endometrial or cervical neoplasia, abnormal endometrial anatomy, compromised immune system, allergy to copper, or Wilson's Disease. The only infection related to the IUD is that associated with insertion. Such an infection is polymicrobial and involves the endogenous, cervicovaginal flora (primarily anaerobes). It is usually asymptomatic and contained by the immune system. 200 mg of Doxycycline can be given orally as a prophylactic 1 hour prior to insertion. A nonprescription, nonsteroidal, anti-inflammatory drug, also taken 1 hour before the procedure, will prevent pain and a vasovagal reaction. Paracervical anesthesia should be used. If the depth of the uterus is less than 6 cm or greater than 10 cm, another form of contraception should be used. Although little research is being done in Canada on new IUDs, the Levonorgestrel IUD from Europe and the CuFix-360 (Flexigard) offer promise. The former, which is T shaped, contains polydimethylsiloxane and levonorgestrel (52 mg, total; releases 20 mcg daily) and can be used for 7 years. The latter IUD is shapeless and consists of 6 copper sleeves strung on surgical nylon thread knotted at 1 end. The knot is inserted, using a needle, into the fundal myometrium. The truth and falsehood of several myths about IUDs are noted with supporting citations.
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PMID:The intrauterine device today. 1231 29

The family planning service at Aristide Le Dantec Hospital in Dakar, Senegal, has begun inserting and removing the contraceptive implant system Norplant. A local anesthetic is injected in the arm, then a trocar (sometimes a scalpel) is used to make a 2 mm incision in the skin of the inner arm. One then inserts the six capsules subdermally through the trocar. After inserting the first capsule, it is necessary to pivot the trocar at a 15 degree angle in order to insert the next capsules. After Norplant insertion and removal of the trocar, health workers wrap gauze around a bandage to secure the site rather than use sutures. The insertion procedure takes only 13 minutes. Norplant protects against pregnancy for five years. The Family Planning Association of the Dominican Republic has trained more than 100 physicians at an international training center in Santo Domingo in the insertion and removal of Norplant. Norplant should be inserted during menstruation or immediately after delivery to assure absence of pregnancy. It should be inserted in lactating women six weeks after delivery. Possible insertion-related complications include pain and itching. They tend to be rare, however, (1%, according to Family Health International's experience), and vary considerably from country to country and from clinic to clinic. An infection at the insertion site and expulsion of implants tend to occur two months after insertion. 37.5% of local reactions occur after the fourth month. Most complications are directly attributable to inexperience, inadequate training, or lack of sterile insertion technique. Malplaced implants are difficult to remove. A 4 mm long incision at the insertion site is required for implant removal. Removal lasts 15-20 minutes. Capsules must be removed at five years and new capsules inserted (usually at the same site) if one still wants to use Norplant. A local anesthetic is needed for removal.
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PMID:[Insertion and removal of Norplant]. 1231 70

A review of 25 clinical trials conducted at the National University in Singapore included 10,055 insertions of 16 different IUDs between 1975 and 1988. The trials were conducted to assess the safety and complications of IUD use. The IUDs were inserted either immediately after abortion or at least 4 weeks after delivery or first trimester abortion. Overall, copper-releasing IUDs performed better than inert IUDs. Copper 7/Gravigard had the poorest pregnancy rate among the copper IUDs (6.3% at 48 months vs. 4.4%) as well as the highest use-related terminations (44.8% at 48 months vs. 33.4%). Use-related terminations included expulsion and terminations for other medical and other personal reasons and pregnancy. The Levonorgestrel Nova T IUD and the Copper T 380Ag IUD had the lowest pregnancy rates (no pregnancies over 5 years and 1 pregnancy in 5 years, respectively), but they were not significantly different than those for the Multiload Copper 250 IUD, the review's standard reference point (3.8% over 4 years). Among progestogen-releasing IUDs, levonorgestrel Nova T had the longest active life. The Copper 7/Gravigard, Lippes loop (size D), Dalkon Shield (standard), and OMGA T (size 1) IUDs had significantly higher pregnancy rates that the review's standard, MLCu250 (p .0001). The Latex leaf was significantly higher only after 12 months use (p .05). The Copper 7/Gravigard, Lippes loop (size D), Nova T, OMGA T (size 1), and Copper T 380Ag IUDs had significantly higher expulsion rates than did MLCu250. Women using the Copper 7/Gravigard, Lippes loop (size D), OMGA T (size 1), and Copper T 220/Proquinsert IUDs suffered significantly more pain/bleeding than those using MLCu250. Copper-releasing IUDs had significantly fewer use-related terminations than did the inert IUDs (p .001). The 2 Multiload IUDs (MLCu250 and MLCu375) had considerably fewer use-related terminations over the first 24 months of use.
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PMID:Intrauterine devices. 1234 58

Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.
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PMID:[Information on advances in sciences and technology. Advances in contraceptive technology]. 1234 21

This paper presents a secondary analysis of 3419 Norplant users from 11 countries throughout Asia, Africa and Latin America. The main objective was to identify the menstrual problems associated with a high risk of early discontinuation of Norplant use. Eligible participants were divided into two groups: those who continued use (n = 2667) for the first 3 years and those who discontinued use because of bleeding or pain (n = 752) during the first 3 years of use. Menstrual characteristics of the women were compared between groups using a logistic regression model with generalized estimating equations. Flow duration of more than 7 days, excessive amount of flow, dysmenorrhea and intermenstrual bleeding for more than 7 days were associated with a significant risk of discontinuation. The highest risk was observed in association with flow duration of more than 7 days (adjusted odds ratios of 1.85, 2.01 and 2.20 at 1, 2 and 3 years, respectively). The appropriate management of prolonged or excessive bleeding, namely by continuous counseling, is essential for successful Norplant use.
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PMID:Characteristics of menstrual problems associated with Norplant discontinuation: results of a multinational study. 1274 60

Women who seek an abortion are motivated to use contraceptive methods afterwards. Because the return of fertility after abortion is immediate, there is a need for effective and safe contraception promptly after the termination of pregnancy. A randomized trial of Mirena and NovaT intrauterine contraceptive devices inserted at the time of elective termination of pregnancy, duration no more than 12 weeks, is reported here. Women were randomized 2:1 resulting in 305 subjects with Mirena and 133 with NovaT as a segment of a larger study of 3000 women. In the Mirena group, two pregnancies at year 4 resulted in a final gross rate of 0.8 at 5 years, which was significantly (p < 0.0004) lower than the corresponding rate of 9.5 with NovaT. Terminations because of expulsion, bleeding problems, pain, pelvic inflammatory disease and other medical reasons were less common in the Mirena group, but not significantly different. The cumulative expulsion gross rate for NovaT at 5 years was 15.4 and for Mirena it was 10.5. Termination rates because of amenorrhea were low in both groups. It is concluded that both devices were well tolerated. Mirena was more effective and the rate of adverse events was lower than with NovaT. Special attention should be paid to the insertion procedure when carried out at the time of abortion.
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PMID:Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up. 1287 84

The prevalence of local signs and symptoms related to the site of insertion of implants, and the association of these signs and symptoms with time of use, skin color and body mass index (BMI) was evaluated among users of the Norplant implant system. Three hundred and three Norplant users attending at the reproductive health clinic of PROFAMILIA in Santo Domingo, Dominican Republic, were asked if they had ever had any discomfort at the site/arm of implant insertion and the implant insertion area was examined and hyperpigmentation and hollowing of the surface was recorded. Half of the subjects reported either pain or paresthesia or both, in almost equal numbers, some time since insertion. Hyperpigmentation was observed in 35.6% and hollowing in 22.4% of the subjects. Report of pain and paresthesia was inversely associated to time of use and to BMI. Hyperpigmentation was directly associated to time of use and darker skin, and hollowing of the arm surface in the implants area with time of use and BMI. Local signs and symptoms were more frequent than previously reported, although they were of mild nature and appeared not to worry most of the users.
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PMID:Local side effects observed among long-term users of norplant contraceptive implants. 1295 23

To improve counselling information to Nigerian family planning clients, we compared non-menstrual events reported by 248 Norplant users and 214 Uniplant users. Women using Norplant were significantly older and of higher parity and greater contraceptive experience than Uniplant users. Other admission characteristics of the two groups were similar. The total women-months of use of Norplant was 2,946 (mean 11.9 +/- 0.6 SE) months while that for Uniplant was 2,315 (mean 10.8 +/- 0.2 SE) months. About 36% of Norplant users and 15% of Uniplant users reported non-menstrual adverse events, the commonest ones being pain/itching at the insertion site, unexplained low abdominal pains and clinically diagnosed pelvic inflammatory disease (PID). The numbers of women reporting drug-related adverse events were 61 (24.6%) and 23 (10.8%), respectively, among Norplant and Uniplant users. Drug-related serious adverse events were reported by 3 (1.2%) Norplant users and 5 (2%) Uniplant users. The adverse events leading to Uniplant removal were severe urticaria, breast lumps, pruritus vulvae, headache with raised blood pressure, adnexal pains and ovarian cysts, and static weight while those leading to Norplant removal were breast lump and headache with raised blood pressure. Weight gain was reported by only 7 (3%) of Norplant users. Although of no serious clinical consequences, drug-related adverse events should be added to the counselling information to prospective users.
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PMID:Nonmenstrual adverse events associated with subdermal contraceptive implants containing normegestrel and levonorgestrel. 1503 62


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