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Query: UMLS:C0598853 (forgetting)
 3,232 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The analysis of compliance with hormonal replacement therapy in postmenopausal women must take into account the physician's knowledge of and willingness to prescribe such treatment and the patient's acceptance of the risks and benefits. Studies have shown that most women receiving oral therapy take their medication only sporadically, and those who discontinue treatment usually do so because of the fear of endometrial cancer. Both physicians and patients should be made aware that the addition of progestogen can greatly lessen this risk. Estrogen therapy has been shown to offer significant benefits, notably a reduction in the incidence of osteoporosis-related fractures. Epidemiologic models can be useful in showing both physicians and patients that hormonal treatment is safe and effective. Noncompliance, stemming from side effects or the problem of forgetting to take medications, can be improved through the use of the transdermal estrogen formulation. This product has been associated with excellent tolerability; local and systemic adverse reactions have been minimal, and any problems with unscheduled bleeding or hyperplasia can be circumvented through the addition of progestogens.
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PMID:Compliance with hormone therapy. 357 53

The cyclic use of natural (estrone sulphate) or synthetic estrogens (ethinyl estradiol; 3-methyl ester of ethinyl estradiol) is shown to be clinically capable of inhibiting fertility, probably by a mechanism which interferes with ovulation. Out of the 3 estrogens used in this experiment, there were "escape" phenomena with estrone sulphate, used in a dose of 3.7 mg. The adverse side effects and signs of intolerance shown in some patients treated with a combination of estrogens and proge stogens, especially during the 1st cycles of treatment, are mainly related to the estrogen contained in the compound. The symptoms are similar with both ethinyl estradiol and its 3-methyl ester. If the combined treatment with estrogens and progestogens if properly followed, fertility inhibition occurs in 100% of the cases. Failures of this therapy are rarely due to intolerance and dropping out, but mainly to forgetting to take the drug. The use of a simpler formula, which elimin ates the need for calculations with respect to the menstruation date, 21 days with treatment and 7 without, is just as effective in inhibiting fertility and the characteristics of menstrual bleeding remain largely unaffected. The reduction of the amount of progestogen leaves the fertility inhibiting property unaffected, if the minimum effective dose of estrogen is maintained. Since the progestogen is the more complex and expensive substance, a reduction would considerably lower the market price of the drug.
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PMID:[Control of human fertility with estrogens and various combinations of estrogens and progestogens. (Experimental study)]. 586 18

Several questions are posed concerning the optimal time for use of the morning- after pill. In general the rule of thumb is that the pill should be used no earlier than 12 hours before unprotected intercourse, not more than 72 hours afterwards (ideally between 12 and 48 hours after intercourse). Another question concerns the issue of whether the instructions for the 2x2 and the 5x5 methods could be identical. With regard to the situation of forgetting to take the pill, the timeliness or lateness of taking a morning-after pill is explored in relationship to the time of coitus. The last question examines whether the effectiveness of the 5x5 method is identical when it is taken in a regimen of 1 mg 5 times per day to when it is taken in a regimen of 5 mg once a day. The 2x2 method is popular, but increasingly information is also available exclusively about the 5x5 method. The crucial question before buying a suboptimal postcoital contraceptive is whether a dominant follicle could possibly develop. A pause in pill use of 7 days hardly gives the follicle the chance to grow into a dominant follicle. Therefore, the use of pills in principle is a reliable method of contraception. The most available method for the prevention of implantation of the blastocyst is the application of an IUD. According to the literature on the subject, the morning-after IUD is particularly reliable up to 5 days after ovulation. Very high-dose ethinyl estradiol (1 mg 5 times per day for 5 days) is another method; it has a 95% effectiveness rate if taken within 36 hours (and, at the latest, 48 hours) after coitus.
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PMID:[When is the morning-after pill indicated and which application is preferable?]. 955 47

Since 1979, Pro Familia, the German Association for Family Planning and Sexual Counselling, has offered a postcoital contraceptive program utilizing either the ethinyl estradiol (EE)-norgestrel combined oral contraceptive (OC) described by Yuzpe in Canada or a levonorgestrel-only regime. In the Yuzpe method, 4 pills each containing .05 mg EE and .5 mg norgestrel are taken, 2 in the 48 hours following the unprotected coitus and the other two 12 hours later. The other method requires that .6 mg of levonorgestrel be taken in the 12 hours following coitus. In 737 cases of administration of postcoital contraceptives in 26 Pro Familia clinics over the past 3 years, 85% of women were under 28 years old and almost 30% were 14-18 years old. The reasons for utilizing a postcoital method varied but were mostly related to the user, such as nonuse of contraception or forgetting of pills. 25% initiated treatment 1-12 hours after the unprotected intercourse, 44% 13-24 hours later, 27% 25-48 hours later, and 4% 49 or more hours later. In 1% of cases the timing was unknown. 54 patients were treated on cycle days 1-9, 435 on days 10-18, 178 on days 19-27, 37 on day 28 or later, and for 22 the cycle day was unknown. 16 intrauterine pregnancies and no tubal pregnancies occurred. The 522 patients receiving the combined OC treatment had 10 pregnancies for a failure rate of 1.9% and the 205 receiving the progestin-only treatment had 6 pregnancies, for a failure rate of 2.9%.
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PMID:[Postcoital contraception]. 1226 28

3 conditions may be responsible for absence of menstruation in women taking the minipill: pregnancy, extrauterine pregnancy, or endometrial atrophy which is the most frequent cause but should be treated only after the other 2 possibilities are excluded. The most frequent cause of pregnancy while taking minipills is error in pill consumption due to forgetting, but malabsorption due to vomiting less than 2 hours after taking the pill or an interaction with some other medication may be responsible. The possibility of extrauterine pregnancy should be systematically considered, and the possibility that a micropill and not a minipill is involved should be ruled out. With a sequential minipill contraceptive efficacy does not reach 100% but iatrogenic amenorrhea is infrequent because of the strong dose of ethinyl estradiol. In the case of a preexisting amenorrhea that does not respond to the estrogen or progestin dose, a prolactin adenoma may be suspected. After 2 consecutive beta tests of pregnancy 8 days apart have been negative, it may be concluded that endometrial atrophy is the cause of the amenorrhea. Unprotected sexual relations should be avoided and the patient should be given a fast-acting combined oral contraceptive such as Lutestral to induce bleeding, after which the minipill can be resumed. If unprotected intercourse occurs there is a risk of pregnancy since amenorrhea and anovulation are not synonymous. A morning after pill can be used if the unprotected sexual relations occurred within the last 72 hours. If a pill was forgotten or probably forgotten before the emenorrhea, the most prudent attitude would be to consider the pill to have been ineffective during the preceding 21 days and to test for pregnancy. Unprotected intercourse should be avoided, a fast-acting combination pill should be prescribed to induce bleeding, and the minipill should then be resumed. Amenorrhea in the 1st month of use after an abortion is not significant. This secondary effect of the minipill should be explained to the patient to avoid unnecessary worry.
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PMID:[Do's and don'ts in treating amenorrhea in women taking the minipill]. 1226 2

This work describes oral contraceptives (OCs) in current use and examines their risks. OC pills are composed of synthetic estrogens, usually either ethinyl estradiol or mestranol, and progestins. Either estrogens or progestins can be used alone, but combinations permit smaller doses to be used. Combined pills are available in monophasic, biphasic, or triphasic formulations. Different modalities of administration are also available for progestin-only pills. The "morning after" pill containing high doses of steroids to be taken within 72 hours of unprotected intercourse can contain either estrogen or progestin alone or combined. The mechanisms of action of OCs vary according to the type of pill. Classic combined OCs inhibit ovulation, render the cervical mucus inhospitable to sperm, and cause endometrial atrophy which hinders nidation. Low-dose pills have various effects but in general depend on changes in the cervical mucus for their contraceptive effect. Pregnancy may result from forgetting pills or using them incorrectly, or in the case of low-dose pills may occur even if they are used correctly. Some drugs can lower the concentrations of the OC hormones at the level of the receptors by hindering their intestinal absorption or by increasing the metabolic power of the liver. Considerable individual variability limits the incidence of pill failure due to drug interactions, but OC use should be avoided if rifampicine or certain other drugs are used. Among undesirable effects of OCs on endocrine glands and reproductive function are the adaptation syndrome characterized by symptoms similar to those of early pregnancy and reversible in most but not all women; galactorrhea resulting from diminished levels of "prolactin inhibiting factor"; and virilizing effects such as alopecia, hirsutism, and acne usually occurring during use of high-dose formulations. Pills should be carefully adapted to the hormonal profile of the user to avoid these side effects. OCs very rarely entail longterm infertility. OCs in current use do not appear to be teratogenic but it is advisable to wait 2 months after termination of use before becoming pregnant. Lactation is a contraindication to OC use. Combined OCs frequently cause problems in glucose tolerance of variable significance. Low-dose progestins do not seem to affect lipid metabolism, but low and normal dose combined pills may provoke increases in the levels of cholesterol and triglycerides. OCs are implicated in vascular accidents of various kinds, but low-dose pills are better tolerated. Cardiovascular risks are increased by age, smoking, use of alcohol, and excess fat in the diet. Hepatobiliary complications may occur during pill use. The carcinogenic role of OCx remains controversial, although growth of preexisting breast cancers is accelerated with pill use. The multifactorial etiologies of cardiovascular ailments, atherosclerosis, and cancerous tumors make the role of OCs difficult to assess. OCs can interact with various drugs, heightening the undesirable effects of each. Research on hormonal methods of contraception is currently directed toward achieving a better tolerance and administration of both male and female methods.
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PMID:[Oral contraception: failures and risks]. 1228 May 90

Changes in combined oral contraceptives (OCs) include reduction in the estrogen and progestogen dose and recourse to the third generation, less androgenic progestogens. They retain the efficacy and convenience of OCs while reducing the metabolic and cardiovascular effects and the need to identify contraindications and subjects at risk. OCs sometimes cause menstrual cycle problems: spotting and intercurrent bleeding or bleeding at any time other than menstruation (metrorrhagia). OCs cause loose and edematous stroma in the endometrium where glands maintain a proliferative-like phase throughout the cycle. Many dilated capillaries with hyperplasia of the endothelial cells rise to the surface. Forgetting or failure to take OC pills are often responsible for intercurrent bleeding. It is hard to determine what OCs cause less bleeding than other OCs. The third generation progestogen, gestodene, appears to have better cycle control than the two other third generation progestogens (desogestrel and norgestimate). It is not clear whether triphasic OCs with second generation progestogens are better than monophasic third generation OCs. The OC with low dose ethinyl estradiol (20 mcg) (Mercilon) has as low a bleeding rate as does the OC, Varnoline (30 mcg). Menstrual cycle disturbances rarely happen. Providers must emphasize to new OC users the possibility of spotting or intercurrent bleeding, especially during the first cycle. Providers must also inform them that these disturbances do not affect the effectiveness of the OCs and that they should not stop taking OCs if they are concerned about bleeding. Providers must instruct them what to do if they forget to take a pill(s). Providers should schedule an appointment after a new OC user has completed the third OC packet. They should do a gynecologic exam to search for a genital infection, endo-uterine polyp or fibroma, and hyperplasia of the endometrium. If bleeding persists during the third cycle, the client should change contraception.
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PMID:[Metrorrhagia caused by estrogen-progestin combinations]. 1231 56

Combined oral contraceptives (OCs) are used by approximately 55 million women throughout the world. Given their effectiveness, easy use, and good tolerance, they will probably continue to be the most used contraceptive method in the developed world for years to come. Research therefore continues with a view to minimizing the rare but serious complications of OCs. Development of new progestins and decreasing of dose levels are 2 goals. The hormonal properties of natural progesterone are well defined. Synthetic progestins have 3 major advantages over natural progesterone: better bioavailability by the oral route, superior progestomimetic activity, and more marked antiestrogenic and antigonadotropic effects. Of the 2 large chemical classes of progestins, those derived from progesterone are primarily used in therapy while those derived from nortestosterone are used in both therapy and contraception. Within these classes, each progestin has a specific pharmacologic profile which determines its uses. The major advantage of the norsteroids for contraception is their strong antiovulatory action, but their varying androgenic properties are responsible for undesirable cutaneous and metabolic side effects. Gestodene, a new progestin, combines a strong antigonadotropic and progestomimetic action with an absence of androgenic and estrogenic effects at contraceptive doses. Tests in rats and mice demonstrate that gestodene inhibits ovulation in 100% of cases at 1/3 the dose of levonorgestrel. The threshold dose for women is the lowest of any of the gonane progestins. Tests of endometrial transformation and affinity to progesterone receptors indicate that gestodene is 3 to 30 times more active than levonorgestrel. Gestodene's strong luteomimetic activity assures reinforcement of contraceptive control by endometrial transformation and permits creation of hormonal balance. Because of its weak androgenic character, gestodene at contraceptive doses causes no modification in lipid or glucose parameters in animals. A new triphasic OC containing gestodene combines 3 successive phases lasting 6, 5, and 10 days with 50, 70, and 100 mcg of gestodene and 30, 40, and 30 mcg of ethinyl estradiol respectively. At these doses the inhibition of ovulation was shown by pelvic sonography, serum levels of estradiol and progesterone, and other tests to be constant. A multicenter study of 27,308 cycles showed a Pearl index of .1 despite forgetting of pills in 669 cycles. The rate of amenorrhea was .3%. Cycle control was excellent. Various studies of the effect on lipid and glucose parameters and on hemostasis demonstrated a high degree of tolerance consistent with the low steroid dose and minimal androgenicity of the progestin.
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PMID:[Thirty years after the appearance of the first oral contraceptive, clinical and biological analysis of a new estrogen-progestin combination, a three phase pill containing gestodene]. 1234 78