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

A table lists the commonly used methods of reversible contraception, their mechanism of action, and some adverse effects -- oral contraceptives (OCs), combined and progestin only; IUDs; the condom; diaphragm with spermicide; cervical cap with spermicide; sponge with spermicide; spermicide; periodic abstinence; and medroxyprogesterone acetate. The progestin-only OCs have a higher failure rate than the combined OCs and may cause irregular bleeding. Their principal indication is for nursing mothers who want to use an OC. To minimize the risk of cardiovascular adverse effects, OCs containing 35 mcg of estrogen or less and a low dose of a progestin are preferred. Most studies have found no overall increase in the incidence of breast cancer in women using OCs, but the possibility remains that the incidence may be increased in some subgroups. The 2 IUDs now marketed in the US -- the Progestasert and the Copper T380A both have a T shape and are medicated. The increased risk of pelvic inflammatory disease associated with IUDs was limited to the 1st few months after insertion in 1 study of 472 women using IUDs other than the Dalkon Shield. The increased risk of ectopic pregnancy appears to be lower with copper-containing devices than with the Progestasert. The advantages of condom use include safety and protection against sexually transmitted diseases, including Acquired Immune Deficiency Syndrome (AIDS). Diaphragms, which also offer some increased protection against sexually transmitted diseases, have been associated with an increased risk of urinary tract infection. The cervical cap, a smaller device than the diaphragm, can be left in place for 48 hours without adding more spermicide and is less messy to use than the diaphragm. The vaginal contraceptive sponge can protect during multiple acts of coitus over a 24-hour period. Nonoxynol-9, the most common spermicide used in the US, is a chemical surfactant that destroys the cell walls of sperm and offers some protection against sexually transmitted diseases. Women with irregular menstrual periods have the greatest risk of failure with periodic abstinence. Medroxyprogesterone acetate is not approved by the US Food and Drug Administration for contraceptive use.
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PMID:Choice of contraceptives. 297 98

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52

A scanning and transmission electron microscopy study was undertaken of the effect of the progesterone releasing intrauterine device (Progestasert, Alza Corporation, USA) on the uterine endometrium and fallopian tube epithelium. Small erosions of surface epithelium and microthrombosis of stromal capillaries were found in the endometrium below the inert part of the device. A reduction of ciliated cells and shortened cilia were seen in the endometrium below the active part of the device and large dilated venules were present in the underlying stroma. Fallopian tubes from IUD patients contained fewer ciliated cells than those of the controls. The morphological changes described are likely to be major factors responsible for the irregular bleeding which occurs with Progestasert IUDs and the possible increase in tubal pregnancy.
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PMID:The effect of the progesterone-releasing intrauterine device on uterine endometrium and fallopian tube epithelium. 695 5

The clinical performance and the in vivo release rate of a single 4-cm Nestorone subdermal implant were investigated. Implants manufactured by two different procedures were compared. Volunteers were 70 healthy women of proven fertility. Forty women provided blood samples twice a week in the pretreatment cycle and for 5-6 weeks at 6-month intervals during treatment. Additional control cycles (n = 31) were studied in 19 Copper T users. No pregnancy occurred in 1570 woman-months. Nestorone plasma levels (x +/- S.E.) declined from 112 +/- 8 to 86 +/- 3 pmol/L (Implant A) and from 145 +/- 8 to 57 +/- 5 pmol/L (Implant B) from the first to the 24th month. Progesterone levels were < 9.5 nmol/L in 166 (93%) of 178 blood samplings taken during treatment. Progesterone levels > 16 nmol/L were found in only 7 sampling periods (3.9%) in treated women and in 70 (98.6%) out of 71 control cycles. No ovulation occurred with Nestorone plasma levels above 105 pmol/L. No abnormal changes were observed in plasma lipoproteins or other clinical chemistry parameters during treatment. The implants were well tolerated. The most frequent complaint was the occurrence of irregular bleeding. Enlarged follicles found during pelvic examination in 8 subjects (11.4%) disappeared spontaneously in 10 days to 6 weeks. Implants were removed because of medical (n = 10, 14.3%) or personal reasons (n = 6, 8.6%) or at the 24th month of treatment (n = 54, 77.1%). The estimated average daily in vivo release rate of Nestorone was 45-50 micrograms/day. A single Nestorone subdermal implant affords efficient contraceptive protection during two years.
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PMID:Clinical trial with Nestorone subdermal contraceptive implants. 775 Feb 82

The current literature on the transmission of HIV and the use of oral contraceptives (OCs), injectables, IUDs, spermicides, and the female condom was reviewed. Some of the methodological difficulties involved study design (observational studies, cross-sectional, case control, and prospective studies) and confounding factors (age, marital status, sexual partners). The impact of OC use on HIV transmission is likely to be minor, but some factors contributing to transmission include cervical ectropion, which enhances HIV transmission. Nevertheless, in a 1990 Nairobi study of 4404 women no such association was detected. Sexually transmitted diseases (STDs) have been risk factors in HIV transmission. OCs that decrease irregular bleeding may protect against HIV. Progestin-only pills could act on the risk of HIV transmission by thickening cervical mucus and thinning the vaginal epithelial layer. 21 epidemiological studies were identified on the use of OCs and transmission. Except for a 1990 Nairobi study among prostitutes none of them reported a significant association between OC use and HIV seropositivity. Injectables (Depo Provera) could theoretically increase HIV transmission, but no such conclusive evidence has surfaced. Increased risk of transmission or seropositivity has been reported with IUD use, but this needs confirmation by prospective studies. Among spermicides the nonoxynol-9 sponge slightly increased HIV seroconversion in 139 sex workers in Nairobi in a 1992 study. However, this trial was contradicted by other prospective studies conducted in Cameroon and Zambia. Nonoxynol-9 kills HIV but also damages the cervical and vaginal mucosa enhancing HIV transmission. In 1992 in vitro activity in 26 out of 131 other spermicides screened inhibited HIV. The female condom was tested in 104 women in a 1993 prospective study in the US and no recurrences of trichomonas occurred in 20 women who used it consistently over a 6-week period. More prospective epidemiological studies are needed, and the risk of HIV infection should be part of counseling on contraceptives.
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PMID:Contraceptive methods and the transmission of HIV: implications for family planning. 820 68

Among 30-40 year old women, 40% of pregnancies are unplanned, which is indicative of the unreliability of the birth control methods they are using. The 1992 Ortho Birth Control Study interviewed almost 7000 women, of whom 8% listed withdrawal and 4% listed the rhythm method. These two methods have failure rates of 24% and 19%, respectively. Birth control methods often disappoint the users and increasingly they turn to sterilization. 48% of married women aged 15-44 had themselves been sterilized or had a sterilized partner in the Ortho survey. Although reversal of tubal ligation succeeds in 43-88% of cases, conception cannot be guaranteed. For women over the age of 30 who are healthy and do not smoke, low-estrogen or no-estrogen oral contraceptive pills are considered safe. Taking the pill also helps prevent ovarian and endometrial cancer. The failure rate is 6%. Barrier methods also offer protection from sexually transmitted diseases including HIV. Condoms are favored by 33% of unmarried women and 19% of married women. Sexually active 40-44 year old unmarried women run a 14-19% risk of contracting a sexually transmitted disease (STD) in a 12-month period. Diaphragms offer some protection against STDs, but their failure rate is 18%. IUDs are regaining popularity, but only 1% of women use them (ParaGard T380A or Progestasert). Pelvic inflammatory disease is the reason: a 1992 study showed that 0.97% of women developed it within 20 days of use. Norplant is a long-term implant containing levonorgestrel with a failure rate of 0.5%. A 1993 study followed 1253 implant users over 12 months and found a very low rate of pregnancy, but 75% experienced some side effects during the first year. About half of the women using Norplant removed it after 2.5 years because of irregular bleeding. Depo-Provera is an injectable administered every 3 months, but after removal it can take up to a year for ovulation to return. Side effects may include hair loss and weight gain; and links to breast cancer have also been suggested.
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PMID:Birth control over 30. 1229 85

This table presents the bleeding disturbances associated with five widely used contraceptive methods. Norplant implant use may cause increased days of light bleeding or spotting/irregular bleeding. Progestin-only injectables are linked to irregular and prolonged bleeding episodes/spotting for the first 3 months, followed by amenorrhea. Bleeding patterns are more predictable in users of combined injectables. Progestin-only oral contraceptives may cause increased days of light bleeding/irregular bleeding and amenorrhea, while combined pills are more likely to cause a decrease in days of bleeding. Copper IUDs increase menstrual blood loss in 30-50% of users, while levonorgestrel-releasing devices significantly decrease bleeding. In sterilization, menstrual changes--if any--tend to reflect changes caused by discontinuation of a prior method.
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PMID:Common bleeding disturbances from method use. 1232 65

Progestin-only minipills have been available for over three decades, yet their use has been limited, because of a documented lower efficacy when compared to pills that combine estrogen and progestin. The availability of a new low-dose progestin-only minipill containing 75 microg desogestrel (DSG) offers a new perspective, since, in a large multicenter study, this minipill gave a crude Pearl index of 0.41 and an adjusted one of 0.14, which is comparable to indices found in clinical trials of oral contraceptives. This minipill also allows for a 12-hour tolerance time in taking the pill. The high effectiveness of the DSG minipill is attributable to an almost constant inhibition of ovulation, as shown by the absence of elevated progesterone circulating levels and inhibition of follicular growth in the vast majority of cycles studied. Since irregular bleeding patterns are observed with all minipills, patterns experienced with DSG 75 microg have been compared to those obtained with levonogestrel 30 microg. As expected, the more pronounced ovarian inhibition produced wider bleeding variability with DSG, but also less bleeding overall. The DSG minipill is suitable for lactating women and represents a valuable addition to oral contraception.
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PMID:Seventy-five microgram desogestrel minipill, a new perspective in estrogen-free contraception. 1464 23

Exogenous estrogen is an effective means of prevention for postmenopausal symptoms. Estrogen treatment should be combined with progesterone in non-hysterectomized women to prevent estrogen-induced malignant transformation of the endometrium. Progesterone supplementation using continuous combined estrogen + progesterone treatment may result in an increased incidence of breast cancer and cardiovascular disease. In addition, progesterone supplementation with sequential estrogen + progesterone treatment may cause immediate adverse effects, such as irregular bleeding and spotting, breast congestion, fluid retention, abdominal distention, and a change in lipid profile. All these effects are related, at least in part, to the progesterone component of the therapy.To avoid these complications, researchers are seeking safer progestational components and different modes of administration. In this article we review the findings on the use of the novel levonorgestrel-releasing intrauterine system as a therapeutic tool for localized, rather than systemic, progesterone administration in postmenopausal women.
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PMID:Levonorgestrel-releasing intrauterine system as an adjunct to estrogen for the treatment of menopausal symptoms--a review. 1722 52