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Query: UMLS:C0745411 (irregular bleeding)
 386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Silastic implants containing the progestin, levonorgestrel, were tested as long-term contraceptives in 101 women. After three full years of exposure and 2,998 woman-months of use, no pregnancies had occurred. The continuation rates were 87% at 12 months, 79% at 24 months and 66% at 36 months. The most important side effect was excessive or irregular bleeding during the first year. No treatment was offered for this side effect other than vitamins and iron or change of method, with the exception of 3 cases where ethinyl estradiol was used one time for 2 weeks each. Bleeding disturbances led 8 patients to ask for removal of implants. Other side effects were headache, acne and lower abdominal pain. Blood and urine analysis tested 17 different parameters and all but plasma cortisol remained within normal limits throughout the study. A general tendency toward lowered cortisol values was observed and two subjects had more than one value below the normal limit for the population during the study. Glucose tolerance tests during the second year were abnormal in two women with familial diabetes but they returned to normal values spontaneously at the next test. It is concluded that levonorgestrel implants offer effective protection against pregnancy during the first three years of continuous use. Their acceptability and few side effects justify larger trials, especially if treatment of bleeding irregularities is introduced.
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PMID:A three-year clinical trial with levonorgestrel silastic implants. 38 43

This study aimed to evaluate the clinical and metabolic effects of a low-dose triphasic oral contraceptive containing gestodene, a new 19-nortestosterone derivative, among 42 healthy women aged 19-43 years during 6 months of treatment. Absence of any absolute or relative contraindications to hormonal contraception was the criterion for the subjects. Findings revealed that the pill exerted good cycle control and the incidence of irregular bleeding was very low. As for the coagulatory system, there was an increase in prothrombin activity and in fibrinopeptide A plasma levels, while there was a decrease in activated partial thromboplastin time. Antithrombin III activity, fibrinogen concentration and platelets count did not change during pill intake. No significant modifications in plasma total cholesterol, low density lipoprotein-cholesterol or in the subfraction high density lipoprotein 2-cholesterol (HDL2-CH) were observed. Serum triglyceride (HDL-CH and HDL3-CH) levels were significantly higher at the end of treatment. The pill did not alter fasting insulin and glucose levels or their response to an oral glucose tolerance test. Therefore, the preliminary findings suggest that the new triphasic formulation containing gestodene seems to be a safe and reliable preparation, as demonstrated by its regular cycle control, good contraceptive efficacy, and low incidence of subjective and objective side effects.
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PMID:Clinical and metabolic effects of a triphasic pill containing gestodene. 148 72

The clinical and metabolic effects of a short-term treatment with a combination contraceptive pill containing 30 mcg ethinylestradiol and 75 mcg gestodene were evaluated in a group of 31 healthy women. The pill exerted good cycle control and the incidence of irregular bleeding was low. Side effects rarely occurred, and an improvement in premenstrual symptoms was reported during pill intake. Among the different biochemical parameters tested to monitor the coagulatory system, the only modification observed was an increase of fibrinopeptide A plasma levels, confirming that low-dose pills have less effects on the haemostatic system than oral contraceptives with a higher estrogen content. No significant modification in plasma total cholesterol, triglycerides, high density lipoprotein-cholesterol (HDL-CH), HDL2-CH, nor low density lipoprotein-cholesterol were observed. HDL3-CH levels were significantly increased. Moreover, the pill did not significantly alter the fasting insulin and glucose levels nor their response to an oral glucose tolerance test. It may be suggested that this new formulation has high efficacy and clinical acceptability, primarily due to the total absence of any adverse metabolic effect.
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PMID:Clinical and metabolic effects of a pill containing 30 mcg ethinylestradiol plus 75 mcg gestodene. 262 May 29

The clinical and metabolic effects of short-term treatment with an oral contraceptive (OC) containing 0.150 mg desogestrel and 20 mcg ethinyl estradiol were evaluated in 17 healthy subjects 19-37 years of age. Despite its low estrogen content, the OC exerted good menstrual cycle control and the incidence of irregular bleeding was low. Side effects often associated with OC use, such as weight gain or changes in blood pressure, did not occur. Moreover, there was improvement of premenstrual symptoms during pill use. The formulation induced a significant increase of fibrinopeptide A plasma levels, although the resulting peptide increase was lower than that induced by OCs containing 30 mcg ethinyl estradiol. No significant alterations of plasma total cholesterol and low-density lipoprotein cholesterol (LDL-C) were recorded, but triglyceride concentrations, high-density lipoprotein cholesterol (HDL-C), and the HDL-C/LDL-C ratio significantly increased. Also observed was a significant increase in concentrations of apolipoproteins AI and AII. Finally, the OC did not alter fasting insulin and glucose levels or their response to an oral glucose tolerance test. These find ngs refute the belief that doses lower than 30 mcg of ethinyl estradiol are inadequate for maintaining satisfactory contraceptive efficacy and good cycle control. The advantages of using a lower estrogen dose were evident both in terms of the low incidence of side effects and the lack of effects on the coagulation system. The present results suggest that this OC formulation could further minimize the thrombogenic effects of low-dose OCs. In addition, this formulation retains the effects on lipid metabolism of OCs containing desogestrel.
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PMID:Clinical and metabolic study of a new pill containing 20 mcg ethinylestradiol plus 0.150 mg desogestrel. 295 55

Advice is provided for nurses and midwives who are asked about the safety and efficacy of the newer oral contraceptives (OCs). The trend toward ever smaller amounts of estrogen in new formulations effectively halted when the quantities of estrogen became insufficient to suppress the hypothalamic-pituitary axis or drug interactions with barbiturates or oral antibiotics resulted in insufficient estrogen, both conditions resulting in higher pregnancy rates. The newest generation of OCs follows 2 basic approaches, phasic OCs and improved progestogens. The triphasic pills Logynon and Trinordiol come in memo-packets with pills of 3 different progestogen-estrogen balances to be taken for 21 days. They contain 30 g less total monthly hormone than any other combined pill, give excellent cycle control and high reliability, and produce minimal metabolic changes. Bi-Novum, a biphasic pill with 35 mcg estrogen, gives cycle stability and minimal nausea, weight gain, and breast tenderness, comparable to results with 50 mcg estrogen. The progestogen used in Bi-Novum produces minimal changes in lipid metabolism and glucose tolerance safety factors. Another new formulation, Marvelon, is a conventional combined type pill containing a new progestogen, desogestrel, which favorably affects high density lipoprotein-cholesterol ratios, remobilizes cholesterol deposits from arterial walls, and reduces the risk of cardiovascular disesase. The progestogen-only formulation Femulen, with a daily dose of 5 mg of ethynodiol diacetate, has high efficacy and a relatively low dropout rate due to irregular bleeding and other causes.
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PMID:When patients ask about the latest and safest oral contraceptive. 692 41

Women entering menopause should be informed of the benefits and risks of hormone replacement therapy and of the variety of regimens available. One option, a continuous combined regimen of conjugated equine estrogen 0.625 mg and medroxyprogesterone acetate 2.5 mg, maintains the beneficial effects of estrogen on cardiovascular risk factors, although its effects on high-density lipoprotein cholesterol levels are less pronounced than with estrogen alone. The addition of progestin does not affect carbohydrate metabolism except for a slight decline in glucose tolerance. Blood coagulation factors and blood pressure showed no clinically significant changes different from those resulting from unopposed estrogen. Bone mineral density is increased more with the continuous combined regimen than with the continuous combined regimen than with a cyclical regimen of the same hormones. The incidence of endometrial hyperplasia is substantially less than that observed with unopposed estrogen. The overall frequency of irregular bleeding is lower than with estrogen alone and diminishes with continuation of therapy, whereas the incidence of amenorrhea increases from 52.1% to 75.1% between cycles 2 and 11. Epidemiologic evidence linking any hormonal therapy with breast cancer remains inconsistent, possibly because the risk, if any, is small. The relative risk of breast cancer for the continuous regimen has not been extensively studied in large-scale studies.
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PMID:Continuous combined estrogen/progestin hormone replacement therapy. 859 34

Some scientists added the progestin levonorgestrel to the vaginal ring which must be removed every 3 weeks to address the problem of irregular bleeding, but it adversely altered lipoprotein levels and caused too many hemorrhaging problems. On the other hand, scientists in the laboratory at Organon have conducted various studies of a vaginal ring with ethinyl estradiol and 3-keto-desogestrel at different doses which have yielded favorable results. A multicenter European study was conducted with 400 women aged 18-40 years wearing a vaginal ring with 0.120 mg keto-desogestrel and 0.015 mg ethinyl estradiol every day for 9 months. 10% had slight bleeding 15 days after insertion of the vaginal ring. In 10 women tested, the plasmal levels of progesterone and estrogen decreased by 4 nmol/l and 0.010 nmol/l, respectively. The first French study was conducted at the Gynecology College of Bordeaux and the South-West in 1988 and included 40 women followed for 9 cycles. The vaginal ring consisted of 2 compartments: the biggest compartment contained only 3-keto-desogestrel and the other also contained ethinyl estradiol. It remained in the vagina for 21 days, then was removed to be rinsed, dried, and placed in a box. It was reinserted on the 5th or 7th day of the cycle. This ring reduces the volume of blood during menses and eliminates abdominal cramps, nausea, and headaches. Women tolerate the vaginal ring better than they do oral contraceptives (OCs); for example, it does not cause them to gain weight, they tolerate glucose well, it brings about favorable changes in lipoproteins, it does not bring about conditions favorable to thrombophlebitis, and it can improve the skin for acne-sufferers. Young women accept vaginal rings enthusiastically. The efficacy of vaginal rings with 2 steroids is the same as that of OCs.
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PMID:[Vaginal contraception with steroids]. 1228

The Norplant System of levonorgestrel implants and the Depo Provera contraceptive Injection of sterile medroxy progesterone acetate suspension (DMPA) are longterm, progestagen-based contraceptive delivery systems designed to overcome noncompliance which are under review for use in Canada. 150 mg of DMPA, a pregnane compound derived from progesterone, is injected every 3 months. Peak plasma concentrations are reached in 24 hours and plateau for 3-4 months before gradually declining. After termination, ovulation returns on average in 4.5 months, and conception occurs at a median time of 10 months. 90% conceive by 24 months. In the Norplant system, a steady daily supply of 50-80 mcg of levonorgestrel, a gonane progestin derived from the testosterone nucleus which has both progestogenic and androgenic receptor affinity, diffuses from 5 Silastic implants, which must be replaced every 5 years. Ovulation and fertility return rapidly after rod removal. The actual and lowest expected failure rates are equal for both systems. The failure rate for DMPA is .3 pregnancies per 100 women years, while that for levonorgestrel is .4% in 1 year. Although neither method affects blood pressure, DMPA appears to affect carbohydrate metabolism by impairing glucose tolerance and increasing insulin production. Lipid metabolism is also affected. 5% of those who use levonorgestrel discontinue it because of side effects, including headache, mastodynia, and acne; 19.1% of DMPA users did so, especially for weight gain and menstrual cycle abnormalities. Both methods have a higher frequency of menstrual abnormalities than normal. 27.7% of levonorgestrel users experienced prolonged bleeding, while 17% experienced spotting during the first 6 months. However, normal menses usually returned within a year, and only 7.9% discontinued use because of cycle abnormalities. In 1 study, less than 10% of DMPA users experienced normal cycles, and in another study 35% experienced amenorrhea (500/700 discontinued use). Amenorrhea replaced irregular bleeding with continued use, occurring in 68% of users by 2 years. There is also some concern about DMPA and breast cancer and bone loss. Based on 1 case-control study of 110 women with breast cancer who had taken DMPA, the relative risk is highest for those between ages 25 and 34 who use DMPA longer than 6 years. A WHO study concluded that the relative risk of developing breast cancer, because of DMPA, is inversely related to duration of use. A Phase IV study on DMPA and bone mineral density has been undertaken.
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PMID:A comparison of levonorgestrel implants with depo-medroxyprogesterone acetate injections for contraception. 1231 30