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Query: UMLS:C0547004 (Intermenstrual bleeding)
 32 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The contraceptive effect of 6 subdermal silastic implants containing norgestrienone was investigated in 659 women of reproductive age for a period of 2 years. 402 subjects completed 1 year of use, 315 women completed 18 months of use, and 283 completed 2 years of use. A total of 8942 woman-months were recorded. 20 pregnancies occurred. 12 pregnancies occurred after 18 months of use. Only 4 pregnancies occurred during the 1st year of use when 7022 woman-months were recorded. The Pearl Index for the 1st year was .6. For 18 months, the Pearl Index rose to 1.2 and for the 2nd year to 2.6. Most important side effects were bleeding irregularities. 23% of subjects missed the 1st expected period following the insertion of the capsules and approximately 20% of all subjects had at least 1 nonbleeding interval longer than 45 days. The incidence of amenorrhea diminished towards the end of the treatment to attain 10% at 1 year and only 5% at 18 months. 361 women (54%) had regular bleeding episodes with mean interval of 29.5 days (standard deviation 1 /SD/ 1 = 3.9) and a duration of 2-6 days (mean 4 SID = 1.9). Intermenstrual bleeding was reported by 8% of the subjects during the 1st month, but only 2% after the 3rd month of use.
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PMID:Eighteen months contraception following subdermal insertion of silastic capsules containing norgestrienone. 4 Aug 92

An extensive review of the literature, supplemented by experimentation on progestagen-only minipills taken continuously finds the 4 most effective progestagens. They were tested for 4358 cycles in 483 women. In general lynestrenol and norethisterone acetate give fairly regular cycles with a longer menstrual period. Intermenstrual bleeding is frequent at the beginning but tends to regulate itself. D-norgestrel seems to give shorter cycles with less intermenstrual bleeding. NOrgestrienone gives longer cycles with less bleeding. Problems include spotting or amenorrhea which are often worrisome for the patient. The advantage of the minidose progestagen-only pill is that it has no estrogen and therefore can be used when estrogen is contraindicated: in the case of tumors, history of thromboembolism, disorders of lipid metabolism, fibromatosis, mastitis, prediabetes, and arterial hypertension.
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PMID:[Oral contraception by means of progestagen-only micropills taken continuously in the light of four recent trials (author's transl)]. 102 28

The new low-dose combination oral contraceptive (OC) containing 75 micrograms of the new progestogen gestodene (GTD) plus 30 micrograms ethinyl estradiol (EE) was clinically tested and compared with a levonorgestrel (LNG) combined pill (150 micrograms LNG plus 30 micrograms EE). In a randomized clinical comparative study (A), 176 women were treated with the GTD-containing pill and 185 with the LNG-containing pill for six cycles. This study was followed by a second multicenter study (B) covering 707 patients taking the GTD-containing pill for up to 24 cycles (total, 9,947 cycles). In a third study (C), metabolic effects were assessed using a randomly organized baseline control trial (pretreatment/treatment cycles); 30 patients received the GTD-containing pill and 30 received the LNG-containing pill. Carbohydrate metabolism, lipid metabolism, and blood clotting were investigated, and an interim analysis was performed after six OC cycles. No pregnancies and no severe side effects occurred in any of the studies. Intermenstrual bleeding decreased as usual during treatment. In the total number of gestodene cycles in studies A and B, there was a 6.9% incidence of spotting, a 0.8% incidence of breakthrough bleeding, and a 0.7% incidence of both spotting and breakthrough bleeding in studies A and B patients taking gestodene. Amenorrhea occurred in 0.6% of cycles. Body weight remained unchanged (+/- 2 kg) after 24 cycles in 80.5% of study B patients taking gestodene. Blood pressure remained normal in about 95% of all study B patients; a normalization was observed in greater than 60% of patients with previously elevated blood pressure. No clinically relevant changes in carbohydrate metabolism, lipid metabolism, or blood clotting were observed in study C. The new GTD-containing low-dose combination pill proved to be a safe and reliable contraceptive agent.
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PMID:Clinical and metabolic effects of gestodene and levonorgestrel. 290 45

3 parenteral progestogens (medroxyprogesterone acetate, northisterone enanthate, and dehydroxyprogesterone acetophenide with estradiol enanthate, DPA) were studied in 907 women during 14,958 cycles over a 10-year period. The findings are summarized in 9 diagrams. The frequency of the principal side effects - intermenstrual bleeding, amenorrhea, headache, dizziness and nervousness - varied with the different substances. Intermenstrual bleeding and amenorrhea were least serious using DPA. When the injections were administered at the appropriate intervals, the drugs were effective and no pregnancies occurred. After suspending the treatment, the menstrual pattern returned to normal and the endometrium was fully regenerated. To date no fetal abnormalities have been reported after discontinuing the treatment.
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PMID:[Injectable contraceptives. 10 years' clinical experience]. 427 10

Answers are provided to common questions about the safety and use of oral contraceptives (OCs). Amenorrhea during OC use has no pathologic significance. It is related to endometrial atrophy resulting from insufficient estrogen after longterm pill use. A formulation with a higher estrogen content may be used for one or two cycles to regenerate the endometrium. If amenorrhea persists for more than a few months after discontinuation of pills, pituitary adenoma should be ruled out. Bromocriptine may be indicated in cases of moderate hyperprolactinemia if pregnancy is desired. All intermenstrual bleeding in pill users should be investigated for organic cause. Once endometrial polyps and other pathologies are ruled out, the cause may be assumed to be functional metrorrhagia due to endometrial atrophy identical to that causing amenorrhea in OC users. Intermenstrual bleeding may occasionally result from interactions with specific classes of drugs. Minor bleeding in the first cycles of pill use is common and usually temporary. Accidentally taking two pills in one day is without consequence. If the interval between pill cycles exceeds one week, there is risk of follicular maturation and a different contraceptive method should be used until the next cycle. Forgetting a combined pill is without consequence for delays of under twelve hours. Another method should be used until the next cycle if two pills are forgotten. Low-dose oral progestins rapidly lose efficacy if not taken at the same time every day. "Morning-after" pills may be used up to 72 hours after unprotected intercourse. The current generation of OCs entails no teratogenic risks. The cause of any pill failure should be sought. There is no increased risk of multiple pregnancy after discontinuation of pills, and fecundity does not decline after longterm pill use. OCs should be avoided by users of some antiepileptic drugs or of drugs that increase hepatic toxicity or act as enzyme inductors. All conditions accompanied by hepatic insufficiency or cholestasis are formal contraindications to pill use. The effect of OCs on development of vaginal mycoses is unclear. OCs may be an effective treatment for dysmenorrhea because of their antiprostaglandin properties and reduced flow.
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PMID:[Oral contraception: users' questions]. 827 90

Menstrual bleeding patterns were investigated in young women taking either a levonorgestrel triphasic, Triquilar, or a norethindrone triphasic, Ortho 7/7/7, two commonly prescribed low-dose oral contraceptives. The levonorgestrel triphasic contains ethinyl estradiol (EE) 30 micrograms + levonorgestrel (LNG) 50 micrograms for the first six days, EE 40 micrograms + LNG 75 micrograms for the following five days, and EE 30 micrograms + LNG 125 micrograms for the last ten days. The norethindrone triphasic contains EE 35 micrograms + norethindrone (NET) 0.5 mg for the first seven days, EE 35 micrograms + NET 0.75 mg for the following seven days and EE 35 micrograms + NET 1.0 mg for the last seven days. Three hundred women from 16 to 25 years of age were randomized to the levonorgestrel triphasic (n = 150) or the norethindrone triphasic (n = 150) groups. Assessments were made from daily diary cards and from bimonthly investigator interviews over 6 pill cycles. The results showed a higher incidence of intermenstrual bleeding (breakthrough bleeding and/or spotting) in the norethindrone triphasic group (NET group) than in the levonorgestrel triphasic group (LNG group): 44.9% of patients (66/147) randomized to the LNG group reported intermenstrual bleeding one or more times during the study compared with 61.9% (91/147) randomized to the NET group (p = 0.0036). Furthermore, in subjects who did not miss any pills, the proportion of patients with intermenstrual bleeding in each cycle was significantly greater (p < 0.02, cycles 1-4, 6; p > 0.05, cycle 5) and was experienced for more days per cycle (p < 0.05, cycle 1) and for more cycles per patient (p < 0.05, 5 cycles) in the NET group compared with the LNG group. Intermenstrual bleeding was also less frequently observed in the LNG group than in the NET group in patients who missed pills (p < 0.05, cycles 3, 5 and 6). In addition, early withdrawal bleeding occurred more often in the NET group than in the LNG group (p < 0.05, cycles 1, 3 and 4). The incidence of amenorrhea was similar in both groups. These results demonstrate a significantly lower incidence of intermenstrual bleeding and therefore better cycle control with the levonorgestrel triphasic Triquilar, compared with the norethindrone triphasic Ortho 7/7/7.
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PMID:A clinical comparison of two triphasic oral contraceptives with levonorgestrel or norethindrone: a prospective, randomized, single-blind study. 843 1

A comparison of cycle control, efficacy and tolerability of two oral contraceptive preparations containing 20 microg ethinylestradiol combined with either 100 microg levonorgestrel (EE/LNG 20/100) or 500 microg norethisterone (EE/NET 20/500) was conducted. These results were compared to a standard reference preparation, containing 30 microg ethinylestradiol combined with 150 microg levonorgestrel (EE/LNG 30/150). Efficacy data from 8,544 treatment cycles were obtained from 767 women. Good cycle control and effective contraception was achieved with the two LNG preparations, however, the cycle control results were less favorable with EE/NET 20/500. The cumulative incidence of women with at least one episode of intermenstrual bleeding from cycles 2 to 7 (primary target variable) was 43.9% for EE/LNG 20/100, 72.7% for EE/NET 20/500, and 15.7% for the standard EE/LNG 30/150. The difference between the 2 20 microg of EE preparations, which favored EE/LNG 20/100, was statistically significant (p = 0.001). The overall spotting rates (cycles 1-13) were 9.3% for EE/LNG 20/100, 21.7% for EE/NET 20/500, and 3.3% for the standard EE/LNG 30/150. Amenorrhea was reported in 7.1% (EE/LNG 20/100), 20.6% (EE/NET 20/500), and 0.9% (standard EE/LNG 30/150), respectively. Intermenstrual bleeding episodes were shorter with EE/LNG 20/100 and EE/LNG 30/150 of the 13 treatment cycles. The study Pearl indices were 0.9 for EE/LNG 20/100, 1.9 for EE/NET 20/500, and 0.0 for EE/LNG 30/150. All three treatments were well tolerated. However, tolerability was somewhat less favorable with EE/NET 20/500. A total of 160 women prematurely discontinued the study for various reasons (EE/LNG 20/100: 7%; EE/NET 20/500: 18%; EE/LNG 30/150: 4%). The overall adverse event incidence rate during the trial was low in all groups. Blood pressure remained largely unaffected. Thirteen serious adverse events were recorded for all treatment groups, all but one were assessed as not related to the treatments. There were no remarkable treatment related differences in mean body weight throughout the study and the laboratory values were largely unaffected in all three treatments groups.
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PMID:Multicenter, comparative study of cycle control, efficacy and tolerability of two low-dose oral contraceptives containing 20 microg ethinylestradiol/100 microg levonorgestrel and 20 microg ethinylestradiol/500 microg norethisterone. 1153 6

Dr. J.M. Manautou, Director of Research, Mexican Institute of Social Security, gave a report on a study of continuous administration of 500 mug. of chlormadinone acetate to regulate fertility without inhibiting ovulation. Smaller doses (400,300 and 250 mug.) were used as well, in fewer patients and with less satisfactory results. The 500 mug. dose was used in 1123 women for a total of 13,202 cycles; 121 of these women received the treatment for 21 uninterrupted cycles. All the women in this study were under 36 years of age. Of the 1123 women on the 500 mug. dose, 40 became pregnant; six of these pregnancies were taken to be method failures because the women denied suspending treatment at any stage, and the other 34 were classed as patient failures. This gave a clinical efficiency for the method of 3.7 pregnancies per 100 woman-years. A special test was carried out on some of the women taking part in the study to check their accuracy regarding omission of treatment. Nearly half of those tested left out one or more tablets without admitting this; the presentation of the tablets did not allow the women to check whether they had omitted tablets or not. Dr. Manautou considered that better presentation would keep the women informed about the number of tablets they had taken and would obviate patient failures. Chlormadinone acetate was taken by 10 women who had become pregnant, until their amenorrhoea was correctly diagnosed. All these pregnancies were normal, with eight male and two female babies. No congenital abnormalities or signs of virilization were found. On continuous administration of chlormadinone acetate, menstrual bleeding occurred at 21-24 day intervals in 11.8% of cycles, at 25-35 day intervals in 65.5% of cycles, and at 36-59 day intervals in 20.6%. In no case did menstruation cease. In only 19 women was there menorrhagia of such proportions that the tablets had to be stopped. Intermenstrual bleeding occurred in 20.3% during the first cycle of administration; this percentage decreased over successive cycles until by the 20st cycle it occurred in only 2.1%. In most cases it was slight. Mechanism of action: This is not yet completely clear, but a number of investigations were carried out to try to discover how the compound acts. In 380 endometrial biopsies, 37.9% were irregularly secretory, 30.5% normally secretory, 15% irregular, 9.5% proliferative, and only 7.1% inactive. Culdoscopic studies were carried out in 50 women; in 37 a corpus luteum was present, in six the ovary appeared inactive, in three there was follicular activity without corpus luteum formation, three had cysts in the ovary, and one had a -corpus luteum not of recent origin. In 18 of the 37 cases in which a corpus luteum was found ovarian biopsy was done. The presence of an active corpus luteum was diagnosed in 12. Cervical mucus was investigated in 115 women between the 12th and 16th days of the first three cycles of continuous treatment. The physico-chemical characteristics of the mucus were modified in a way that made it hostile to the entry of sperms. Further, more precise, tests on the cervical mucus will need to be done to reach definite conclusions in this respect. There was a low incidence of side-effects caused by hormonal imbalance, such as nausea, vomiting, chloasma, and mastalgia. The only side-effect that was troublesome was breakthrough bleeding.
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PMID:Low-dose oral products. 1225 2

Ex Luton, an estrogen-free pill composed of 0.5 mg lynestrenol was given to 92 nonlactating women of proven fertility attending the Family Planning Clinic in the Misr Spinning and Weaving Company's Hospital at Mehalla-Kubra, Egypt. 695 cycles were given: 30 women received the pill for less than 6 cycles, and 62 for more than 6. 31 of the 62 continued the pill for more than 12 cycles. Pills were given daily without interruption. There were no cases of pregnancy during regular use. 2 cases of pregnancy occurred due to patient failure, 1 missing 6 pills in the 2nd cycle, and the other missing 2 in the 6th. 2 women who dropped out of the program because they wished to become pregnant did so: 1 who had taken only 1 cycle of pills became pregnant 1 month after dropping out; the 2nd completed 12 cycles and became pregnant 5 months after dropping out. The most common side effects that occur with combined pills appeared to be less frequent in the current study. Headache, nausea and sense of weakness, all present before use of the pill, either decreased or increased only slightly afterwards. Although amenorrhea was reported by 27% of the women after pill use -- a 5-fold increase -- it was noted in only 11.6% of the cycles and was not permanent, although 9 women dropped the pill because of it. Intermenstrual bleeding was a complaint of 12 women before pill use, and of 13 after. It was present only in 17 cycles, but was severe enough in 6 cases to make them drop the pill.
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PMID:Use of an oestrogen-free pill (Ex Luton) for contraception. 1231 Oct 50

Between the fall of 1991 and the fall of 1992, 1500 physicians from throughout France followed 5989 women, 13-56 years old, using the combined oral contraceptive (OC) Moneva (30 mcg ethinyl estradiol and 75 mcg of the new generation progestogen, gestodene) for 3-6 months for a total of 29,000 cycles. Moneva was prescribed in 60% of the cases because the women did not tolerate a previous OC. Moneva effectively prevented pregnancy. It reduced the rate of abnormal cycles (5.4% of cycles vs. 0.9% at 3 months and 0.6% at 6 months). Intermenstrual bleeding also decreased in frequency from 13.8% to 6.1% at 6 months. Amenorrhea occurred less often with Moneva (2.8% vs. 1.1% at 3 and 6 months). Moneva also reduced the length of the menstrual period (20.7% of women with long period vs. 3.3% at 6 months) and excessive menstruation (1.4% vs. 0.2% at 6 months). Pain during menstruation, breast tenderness, and secondary effects occurred less frequently as well (37.1% vs. 13.5% at 3 months and 9/7% at 6 months, 13% vs. 7.9% at 6 months, and 15.1% vs. 11.1% at 3 months and 9% at 6 months, respectively). Secondary effects included headaches, nausea, and heavy legs. Moneva did not affect body weight or arterial blood pressure. 95% of women who took Moneva for 6 months were satisfied with it. 83.8% said that they would continue to use it. In conclusion, Moneva is an effective, safe, tolerable, and acceptable OC for women of all ages.
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PMID:[Oral contraception with Moneva: findings of a cohort study of 6000 women]. 1231 72


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