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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

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

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

New types of contraception approved for use in the US include two long-lasting, hormone-based contraceptives, Depo-Provera and Norplant, and the female condom. The female condom is made of polyurethane, which is thinner, stronger, and a better conductor of heat than latex. Its inner ring fits over the cervix and the outer ring protects the labia and the base of the penis. Its typical-use and perfect-use failure rates are 21-26% and around 5%, respectively. One injection of Depo-Provera blocks ovulation for 3 months. Irregular periods are common with Depo-Provera use. Fertility may not return for 6-12 months after discontinuation. Depo-Provera may protect against endometrial cancer. The 6-capsule system Norplant is inserted subdermally in the arm and releases levonorgestrel for up to 5 years. Since its arrival on the US market, more than 900,000 women have used Norplant. Contraindications to Norplant are liver disease, blood clots, inflammation of the veins, history of breast cancer, or breast feeding in the first 6 weeks postpartum. More than 600,000 US women undergo sterilization annually. 25% of all heterosexually active, fertile women of reproductive age and 60% of these women ages 35-44 have had a tubal ligation. Vasectomy is less risky than tubal ligation. Both vasectomy and tubal sterilization are more than 99% effective. Oral contraceptives (OCs) suppress ovulation. 28% of US women of reproductive age use OCs. OCs are more than 99% effective. OCs appear to increase the risk of blood clots, heart attack, and stroke for smokers over 35. Health benefits of OCs include protection against ovarian cancer, endometrial cancer, pelvic inflammatory disease, ovarian cysts, and benign breast tumors. Barrier methods keep sperm from joining the egg. Latex condoms protect against sexually transmitted diseases (STDs). IUDs interfere with sperm transport and egg fertilization. In the US, there is a perception that IUD use is unsafe. Women with new or multiple partners should use condoms to protect against STDs.
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PMID:Choosing a contraceptive. What's best for you? 1229 May 58

Legal action has been taken in several US cities against Wyeth-Ayerst's Norplant, claiming that labels were deceptive regarding the potential side effects and the difficulties possible with removal. All the lawsuits claimed suffering caused by removals. 25 women in Miami, Florida, filed suit for $50,000 each in damages due to difficult removal. 8 women from Maryland joined 600 women filing in Chicago, who seek $20,000 to $50,000 for damages due to difficult removals and scarring. The group of plaintiffs also have asked for an injunction preventing the company from selling Norplant to doctors without proper training. Wyeth-Ayerst reported that it requested label changes before the lawsuits were filed. The label now states that removals and insertions are possible, without designating the time allocation required; prior labels indicated a 15-20 minute period. The new label includes possible side effects of emotional instability, heart attack, stroke, migraine, arm pain, numbness and tingling. One Maryland woman requested removal because the capsules had shifted and one had moved from her upper arm to under her armpit. Removal required 3 stages totaling 3 hours and ultrasound detection. Another women gained 20 pounds and had a sore arm. Norplant was first introduced in the US in 1991 after 20 years of experience with use worldwide. The contraceptive is effective for 5 years after insertion of 6 capsules, with slow releasing hormones. Planned Parenthood of Maryland administers Norplant at 7 clinics throughout the state, by practitioners at several clinics, and by the Baltimore City health department in school-based clinics. City clinics since 1991 have made 198 insertions and 14 removals, with no problems with removals. School-based clinics have inserted 45 implants and no removals. Bayview Clinic in Baltimore has made 2000 insertions and 250 removals, with few difficulties. The chief of obstetrics and gynecology at Bayview said that it takes about 6 times before removal is perfected by even a trained doctor. The Population Council, which developed Norplant and licensed it to Wyeth-Ayerst, still supports it as one of the most effective, reversible methods of birth control.
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PMID:Norplant removals spur suits. Some recipients report problems. 1231 99

Primary care physicians often prescribe contraceptives to women of reproductive age with comorbidities. Novel delivery systems (e.g., contraceptive patch, contraceptive ring, single-rod implantable device) may change traditional risk and benefit profiles in women with comorbidities. Effective contraceptive counseling requires an understanding of a woman's preferences and medical history, as well as the risks, benefits, adverse effects, and contraindications of each method. Noncontraceptive benefits of combined hormonal contraceptives, such as oral contraceptive pills, include regulated menses, decreased dysmenorrhea, and diminished premenstrual dysphoric disorder. Oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes mellitus, depression, and uncomplicated valvular heart disease. However, women older than 35 years who smoke should avoid oral contraceptive pills. Contraceptives containing estrogen, which can increase thrombotic risk, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease. Progestin-only contraceptives are recommended for women with contraindications to estrogen. Depo-Provera, a long-acting injectable contraceptive, may be preferred in women with sickle cell disease because it reduces the frequency of painful crises. Because of the interaction between antiepileptics and oral contraceptive pills, Depo-Provera may also be considered in women with epilepsy. Implanon, the single-rod implantable contraceptive device, may reduce symptoms of dysmenorrhea. Mirena, the levonorgestrel-containing intrauterine contraceptive system, is an option for women with menorrhagia, endometriosis, or chronic pelvic pain.
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PMID:Contraception choices in women with underlying medical conditions. 2176 49