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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

5 cases of vascular complications--hemorrhagic stroke, myocardial infarction, retinal vein thrombosis, thrombotic stroke and deep vein thrombosis--in young women taking low dose oral contraceptives are described from the Department of Obstetrics and Gynecology, University of the Witwatersrand, Johannesburg, South Africa. The hemorrhagic stroke occurred in 1987 in a 24-year old heavy smoker taking Triphasil (Wyeth) for 12 months. She recovered fully. A 34-year old woman had an anteroseptal infarction while on Minovlar ED (Schering, 50 mcg ethinyl estradiol and 1 mg norethisterone acetate) for 2 years. She had no risk factors other than smoking 5 cigarettes daily. The woman with retinal vein thrombosis had 2 episodes, the 1st while taking Restovar 28 (Organon, 37.5 mcg ethinyl estradiol and 0.75 mg lynestrenol) for 7 years. 19 months later she began Diane (Schering AG, 50 mcg ethinyl estradiol and 2 mg cyproterone acetate) and had a bilateral retinal vein thrombosis leaving her partially blind. The woman with thrombotic stroke was 24 when she was struck in 1986, after 1 year of taking Logynon ED (Schering AG, 6/5/7 days, 30,40/40 mcg ethinyl estradiol and o.5/0.75/0.125 mg levonorgestrel). The patient with deep vein thrombosis was 19, smoked, and had used Triphasil for 2.5 years.
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PMID:Vascular complications in women using the low steroid content combined oral contraceptive pills: case reports and review of the literature. 220 50

Three studies directly evaluated the effects of oral contraceptive (OC) use on migraine headache frequency. The Walnut Creek Study in 1980 was unable to demonstrate a higher frequency of migraine headache in OC users discharged from the hospital as compared with nonusers. Another study in 1978 evaluated the effect of 0.5 mg of norgestrel and 50 mcg of ethinyl estradiol (Ovral) on 40 migraine sufferers. 20 patients received this preparation for the first 2 months of the study, the other 20 did not. 29 patients experienced worsening of their headaches with OC use. However, one-third of the patients did note improvement in their headaches. A third study in 1976 of women suffering from migraine suggested that about one-third of women noted worsening of their headaches while taking OCs. The risks of cerebrovascular accident (CVA) include advancing age, smoking, and the use of high-dose pills. Increase in blood pressure, platelet aggregatability, and cholesterol deposition are the three known mechanisms of the risk of stroke. No blind study of the subject has even been made, and a significant minority of OC users reported improvements in their migraine headaches. Circumstantial evidence suggests that there is an increased risk of stroke in OC users, although these case control studies differed with regard to the degree of relative risk. Two of three cohort studies were unable to demonstrate the increased risk of CVA among these women. The absolute risk of thrombotic stroke remains small for OC users, and the absolute risk is probably very small even for those taking OCs. However, the risk of hemorrhagic stroke may increase fivefold in those smoking. For nonsmokers, OC use is probably safer in all age groups than no contraception. A 1977 study showed that 40-44 year old nonsmokers taking OCs had an estimated death rate of 7/100,000. In contrast, those who used no method of contraception had a higher mortality rate of 23/100,000.
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PMID:Relationship of migraine headache and stroke to oral contraceptive use. 354 Feb 97

We studied 374 women taking oral contraceptives, 284 women taking estrogen preparations after menopause, and 1086 women taking no hormones, to determine the relation of plasma lipids and lipoprotein cholesterol concentrations to various types of estrogen/progestin formulations. Premenopausal women, using oral contraceptives containing a relatively low dose of estrogen combined with a medium or high dose of progestin (Norlestrin, Ovral, or Demulen) had a 24 per cent higher median concentration of low-density-lipoprotein cholesterol than did those not using hormones (P less than 0.05). Women using oral contraceptives that are high in estrogen and low in progestin (Enovid or Oracon) had significantly higher concentrations of high-density-lipoprotein cholesterol than did nonusers; those using Ovral, a low-estrogen and high-progestin formulation, had significantly lower levels of high-density-lipoprotein cholesterol. In postmenopausal women the use of estrogen was associated with concentrations of low-density-lipoprotein cholesterol that were 11 to 19 per cent below the levels in postmenopausal women who did not use hormones. The effects of estrogen-progestin balance on low-density and high-density lipoproteins may underlie the increased incidence of stroke and myocardial infarction in women of childbearing age who take oral contraceptives.
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PMID:Effect of estrogen/progestin potency on lipid/lipoprotein cholesterol. 657 85

The role of progestogen in vascular complications is currently being investigated. The Committee on Safety of Medicines in the United Kingdom has examined 2000 reports of vascular complications related to the hormonal content of oral contraceptives, in particular, norethisterone acetate and levonorgestrel. The 1st progestogen was combined with 50 mcg estrogen and the 2nd with 30 mcg. A significant statistical association was observed between higher doses of norethisterone acetate and death from ischemic heart disease and stroke. There was also a correlation with nonfatal events from the 2 conditions, but not with risk of hypertension or venous thrombosis. Levonorgestrel had an excess of stroke but no association with hypertension and venous thrombosis. In considering the estrogen content of the oral contraceptives, the 30 mcg estrogen had fewer deaths and less ischemic heart disease than was observed with 50 mcg estrogen. These data suggest that lowering the progestogen content of oral contraceptives should reduce the risk of arterial thromboembolism. It also reinforces the value of lower estrogen content. The risks of thromboembolism appear to be age-related, and if the risks are not acceptable to the woman who has completed her family or is over the age of 30, other well-tried alternatives should be considered. The ideal oral contraceptive is yet to be developed.
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PMID:Oral contraception and thromboembolism: the role of progestogens. 693 46

In 1991, the U.S. Food and Drug Administration approved Norplant manufactured in Finland for American use. It has had over 500,000 users in almost 50 nations. It is sold as a set of 6 capsules, each containing 36 mg of levonorgestrel, which are implanted subdermally no on the medial upper arm. An American cohort of Norplant users had the following annual Pearl pregnancy rates: (a) 355 women at 1 year, 0; (b) 283 women at 2 years, 2.1; (c) 191 women at 3 years, 3.1; (d) 69 women at 4 years, 0; and (e) 25 women at 5 years, 0. The cumulative continuation rates for 396 American Norplant users were 82% at 1 year, 65% at 2 years, 50% at 3 years, and 44% at 4 years. A 2nd American cohort and groups of Norplant users in Chile, Egypt, and Thailand had higher continuation rates. Among 110 former Norplant users in San Francisco, 61% planned to use it again. The user can conceive in just 1 month after Norplant removal Many women do experience alterations in menstrual patterns, including prolonged bleeding, spotting between periods, and very light or no bleeding. The ectopic pregnancy rate has been 0.28 per 1000 woman-years of Norplant use, an incidence lower than that of ectopic pregnancies in women not using family planning. Norplant is appropriate for many women who want continuous long-term contraception. Definite contraindications to Norplant include: (a) acute liver disease, including benign or malignant tumors; (b) jaundice; (c) undiagnosed vaginal bleeding; (d) a history of thrombophlebitis, pulmonary embolism, or blood clots in the eyes; (e) a history of heart attack, chest pain as a symptom of diagnoses heart disease, or stroke (coronary artery or cerebrovascular disease); (f) possible pregnancy; (g) lactation until at least 6 weeks postpartum; (h) hemorrhagic disorder; (i) anticoagulation therapy; and (j) drugs such as rifampin, barbiturates, phenytoin, carbamazepine, phenylbutazone, and isoniazid, which may interact with the levonorgestrel in Norplant and decrease its effectiveness.
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PMID:Norplant: a welcome new contraceptive. 848 56

A 1995 publication submitted to the US Food and Drug Administration's MedWatch Spontaneous Reporting System in 1995 identified 14 hospitalizations for stroke in US Norplant contraceptive implant users. This paper reports the findings of a pooled analysis of data from two large population-based case-control studies conducted in California and Washington. Of the 518 stroke patients and their 1547 healthy controls, only 1 stroke patient, 1 ischemic stroke patient, and 3 controls were current Norplant users. After adjustment for age, the odds ratio (OR) for stroke in current compared with noncurrent users of Norplant was 1.0 (95% confidence interval (CI), 0.1-9.2). In addition, 307 myocardial infarction patients and their 1048 controls were available for analysis. Of these, 1 case and 1 control were current users of Norplant. The age-adjusted OR for myocardial infarction in current compared with noncurrent Norplant users was 3.5 (95% CI, 0.2-56.5). The low prevalence of Norplant use in these studies, combined with the rarity of cardiovascular events in women of reproductive age, limited the statistical power of the pooled analysis to determine whether Norplant use increases, decreases, or has no effect on the risk of cardiovascular disease.
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PMID:Norplant implants and cardiovascular disease. 967 45

Couples in the Philippines are free to choose the family planning method that best satisfies their health needs and religious beliefs. All service delivery outlets of the Philippines Department of Health and participating agencies should have all approved, safe, effective, and legal family planning methods available. Oral contraceptives (OCs), IUDs, tubal ligation, and vasectomy are at least 92% effective. OCs protect against pelvic infection and reduce the risk of ovarian and uterine cancer. Older OC users who smoke face an increased risk of blood clotting, stroke, and heart attack. The progestogen-only pill is the best OC for lactating women. The IUD can be effective for 6 years assuming no pain or other side effects. Breast feeding mothers can use the IUD safely. IUD contraindications are anemia, active cervical or pelvic infection, abnormal vaginal bleeding, and genital cancer. Condoms protect against pregnancy as well as sexually transmitted diseases, including HIV/AIDS. When practiced correctly, natural family planning methods are 70-90% effective. They are the cervical mucus method, basal body temperature method, sympto-thermal method, and breast feeding. Norplant contraceptive implants are available to Philippine women on a trial basis. They release a progestin slowly into the blood stream, suppressing ovulation and thickening cervical mucus. The long-acting contraceptive injectables are DMPA, Cycloprovera, and HRP 102. Women must receive an injection every 3 months to protect against pregnancy. The first injection should occur within the first 5 days of the menstrual cycle. Women choosing tubal ligation and men choosing vasectomy should be sure in their decision because they are permanent methods and sterilization reversal procedures are rare in the Philippines. Men with diabetes, an infection at the incision site, clotting disorders, enlarged or painful testicles, and an inguinal hernia should not have a vasectomy.
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PMID:The family planning methods. 1217 21

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

This discussion of systemics covers oral contraceptives (OCs), injectables, depot medroxyprogesterone acetate (DMPA), known as Depo-Provera; and Norplant implants and injectable microspheres of norethisterone (NET). To minimize the side effects of OCs, pharmaceutical companies have worked to get OCs with the lowest possible dose of hormones that is still effective. Family Health International (FHI) has conducted several studies around the world comparing low-dose and standard-dose pills. A new FHI study will determine the acceptability of switching from standard-dose to low-dose pills. FHI also is undertaking a study of OCs with and without iron supplements among women with low hemoglobin counts to see if 7 days of iron each month causes a rise in the hemoglobin and if side effects are higher for the group taking iron supplements. The estrogen component of combined OCs has been associated with suppression of lactation. This is of serious concern, particularly for breastfeeding women with no alternative method of feeding their infants. While increasing the risk of some diseases (such as myocardial infarction and stroke), OCs provide protection from others. Over 100,000 Latin American women use injectable steroidal contraceptives. The World Health Organization (WHO) and FHI are collaborating on a study to compare 2 injectables. The study will evaluate effectiveness, side effects, and user satisfaction for each formulation. A new FHI study in Costa Rica addresses the question of whether longterm users of OCs or Depo-Provera run an increases risk of breast cancer or cervical cancer. The short-term safety and efficacy of Norplant implants has been established, and it has been approved for marketing in Finland. The primary objectives of FHI's clinical trials are to introduce the NORPLANT implant system into countries with no previous experience with this method and to determine overall acceptability of the method in different patient populations. By 1985 or early 1986, FHI will initiate studies in several Latin American countries. Every woman receiving the NORPLANT system will be followed up every 6 months for 5 years, the life of the system. Animals studies of the NET microspheres are concluding. There are plans to test it in a small number of women.
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PMID:Systemics. 1228 Jan 31


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