RESUMEN
BACKGROUND: The contraceptive skin patch (CSP) accepted by the U.S. FDA in 2001 includes ethinylestradiol and norelgestromine, whereas the subdermal contraceptive implant (SCI) has etonogestrel and is also approved by the FDA. In Mexico, both are now widely used for contraception but their effects on Mexican population are unknown. The objective of the study was to evaluate if these treatments induce metabolic changes in a sample of indigenous and mestizo Mexican women. METHODS: An observational, prospective, longitudinal, non-randomized study of women between 18 and 35 years of age assigned to CSP or SCI. We performed several laboratory tests: clinical chemistry, lipid profile, and liver and thyroid function tests. Also, serum levels of insulin, C-peptide, IGF-1, leptin, adiponectin, and C reactive protein were assayed. RESULTS: Sixty-two women were enrolled, 25 used CSP (0 indigenous; 25 mestizos) and 37 used SCI (18 indigenous; 19 mestizos). Clinical symptoms were relatively more frequent in the SCI group. Thirty-four contraceptive users gained weight without other clinical significant changes. After 4 months of treatment, significant changes were found in some biochemical parameters in both treatment groups. Most were clinically irrelevant. Interestingly, the percentage of users with an abnormal atherogenic index diminished from 75% to 41.6% after follow-up. CONCLUSIONS: The CSP slightly modified the metabolic variables. Most changes were nonsignificant, whereas for SCI users changes were more evident and perhaps beneficial. Results of this attempt to evaluate the effects of contraceptives in mestizo and native-American populations show that clinical symptoms are frequent in Mexican users of CSP and SCI. Although these medications may affect some metabolic variables, these changes seem clinically irrelevant. Induction of abnormalities in other physiological pathways cannot be ruled out.
Asunto(s)
Anticonceptivos Femeninos/efectos adversos , Desogestrel/efectos adversos , Etinilestradiol/efectos adversos , Norgestrel/análogos & derivados , Adiponectina/sangre , Adulto , Péptido C/sangre , Proteína C-Reactiva/metabolismo , Anticonceptivos Femeninos/administración & dosificación , Desogestrel/administración & dosificación , Combinación de Medicamentos , Etinilestradiol/administración & dosificación , Femenino , Humanos , Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Leptina/sangre , Metabolismo de los Lípidos/efectos de los fármacos , Pruebas de Función Hepática , Estudios Longitudinales , México , Norgestrel/administración & dosificación , Norgestrel/efectos adversos , Oximas/administración & dosificación , Oximas/efectos adversos , Pruebas de Función de la Tiroides , Parche Transdérmico , Aumento de Peso/efectos de los fármacosRESUMEN
OBJECTIVE: To compare the bleeding patterns, satisfaction and tolerability of 3 different contraceptive in an extended regimens in the service of Family Planning of the North Central Hospital of PEMEX. MATERIAL AND METHODS: Healthy, adult women with desire of contraception for one year (N 120) were randomly assigned to receive oral contraceptive drospirenone/ethinyl E2 (group1), the norelgestromin/ethinyl E2 transdermal patch (group 2) and vaginal ring etonogestrel/ ethinyl E2 (group 3) in an extended regimen (42 consecutive days, 1 hormone-free week). Study assessments were conducted at scheduled visits at the time of initial screening, at baseline after 1, 3, 6, and 12 months. Subjects recorded menstrual associated symptoms bleeding data and completed satisfaction questionnaires. Subjects and investigators provided overall assessments of the regimens. RESULTS: Extended use of 3 different contraceptive resulted in fewer bleeding days in every group (66.6%, 55% and 58.3% P 0.0024), and less mastalgia and menstrual pain. Subjects were highly satisfied with three regimens (93.3%, 96.6% and 91.6% P 0.00421). Although not mayor adverse events were reported with this regimen, there was an increase in spotting days; it decreased with each successive cycle of therapy. Efficacy and safety were similar to those reported for traditional cycle. CONCLUSION: Extended-contraceptive regimen delays menses and reduces bleeding, a profile that may be preferred by women who seek flexibility with their contraceptive method.
Asunto(s)
Androstenos/farmacología , Anticonceptivos Orales Combinados/farmacología , Anticonceptivos Hormonales Orales/farmacología , Desogestrel/farmacología , Etinilestradiol/farmacología , Ciclo Menstrual/efectos de los fármacos , Norgestrel/análogos & derivados , Administración Cutánea , Adolescente , Adulto , Androstenos/administración & dosificación , Androstenos/efectos adversos , Enfermedades de la Mama/inducido químicamente , Dispositivos Anticonceptivos Femeninos , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Hormonales Orales/efectos adversos , Desogestrel/administración & dosificación , Desogestrel/efectos adversos , Combinación de Medicamentos , Dismenorrea/prevención & control , Etinilestradiol/administración & dosificación , Etinilestradiol/efectos adversos , Femenino , Cefalea/inducido químicamente , Humanos , Norgestrel/administración & dosificación , Norgestrel/efectos adversos , Norgestrel/farmacología , Aceptación de la Atención de Salud , Estudios Prospectivos , Factores de Tiempo , Hemorragia Uterina/inducido químicamente , Adulto JovenAsunto(s)
Anticonceptivos Femeninos/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Etinilestradiol/efectos adversos , Norgestrel/análogos & derivados , Administración Cutánea , Adolescente , Anticonceptivos Femeninos/administración & dosificación , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Combinación de Medicamentos , Etinilestradiol/administración & dosificación , Femenino , Glucocorticoides/administración & dosificación , Humanos , Norgestrel/administración & dosificación , Norgestrel/efectos adversosRESUMEN
In the following article, the most recent knowledge on emergency contraception (EC) is reviewed. EC is defined as those contraceptive methods that may be used to prevent an unwanted pregnancy up to 3 days after unprotected intercourse, contraceptive failure or rape. In case of non-hormonal methods (IUD), the time window for pregnancy prevention goes up to 5 days after intercourse. The different regimens now available, hormonal and non-hormonal methods, indications, contraceptive effectiveness, side effects and safety profile, possible mechanisms of action and counseling strategies will be reviewed. The potential benefits on reproductive health of wide-spread knowledge and easy, non-restrictive access to this methodology are emphasized. An extensive list of recent references is enclosed.
Asunto(s)
Anticonceptivos Orales Combinados , Anticonceptivos Hormonales Poscoito , Anticonceptivos Sintéticos Poscoito , Urgencias Médicas , Etinilestradiol , Norgestrel , Adolescente , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Poscoito/administración & dosificación , Anticonceptivos Hormonales Poscoito/efectos adversos , Anticonceptivos Sintéticos Poscoito/efectos adversos , Análisis Costo-Beneficio , Costos de los Medicamentos , Etinilestradiol/administración & dosificación , Etinilestradiol/efectos adversos , Femenino , Humanos , Idoxuridina , Masculino , Náusea/inducido químicamente , Norgestrel/administración & dosificación , Norgestrel/efectos adversos , Embarazo , Progestinas/administración & dosificación , Progestinas/efectos adversos , Vómitos/inducido químicamenteRESUMEN
A comparative multicenter clinical trial of two combined oral contraceptives (OCs) was conducted at clinics located in the Sudan, Sri Lanka, Chile, the Dominican Republic and Ecuador. The trial was designed to determine if there were differences in efficacy, safety and acceptability between a triphasic and a low-dose monophasic OC. This report includes analysis of 1088 women. At each center, subjects were randomly allocated to one of the two OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. There were two accidental pregnancies attributed to user failure reported during the study period; one in the triphasic group and one in the monophasic group. Adverse experiences were mainly minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. Cycle control was good in both groups with women in the triphasic group reporting fewer complaints of intermenstrual bleeding. Both OCs were safe and effective.
PIP: Researchers compared the efficacy, safety, and acceptability of a triphasic oral contraceptive (OC), Triquilar, with those of a monophasic OC, Lo-Femenal, among 1088 women attending clinics in Chile, the Dominican Republic, Ecuador, Sri Lanka, and the Sudan. Both OCs contained levonorgestrel and ethinyl estradiol. 90% of women in each group exhibited good user compliance. Only 1 unplanned pregnancy occurred in each group, and both pregnancies were attributed to user failure. The gross cumulative efficacy rates at 11 months were 0.3/100 woman-years for the triphasic OC and 0.2/100 woman-years for the monophasic OC. The continuation rate at 11 months was lower for Lo-Femenal than it was for Triquilar (80.8% vs. 84.6%), but the difference was not significant. The leading side-effect-related reason for discontinuation in both groups was headache. Another key reason for OC discontinuation in both groups was personal reasons, such as planning a pregnancy. Most women in both groups did not have menstrual complaints (78.8% for the Triquilar group and 77.1% for the Lo-Femenal group). Intermenstrual bleeding rates were low (7.6% for the Triquilar group and 9% for the Lo-Femenal group). Significant intercenter differences for women reporting intermenstrual bleeding and side effects (e.g., headaches) existed (p .05). Women from both groups at the clinic in the Sudan always had lower reports of intermenstrual bleeding than those at the other clinics. In fact, no woman discontinued OC use because of intermenstrual bleeding in the Sudan. Women in Sri Lanka reported fewer side effects than those in other countries, suggesting they could better tolerate OCs than the other women. This multicenter study's findings indicates that both Triquilar and Lo-Femenal are effective and safe. In addition, they exhibit good cycle control.
Asunto(s)
Anticonceptivos Orales Combinados , Adolescente , Adulto , Chile , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Orales Combinados/efectos adversos , República Dominicana , Ecuador , Etinilestradiol/administración & dosificación , Etinilestradiol/efectos adversos , Combinación Etinil Estradiol-Norgestrel , Femenino , Humanos , Levonorgestrel/administración & dosificación , Levonorgestrel/efectos adversos , Norgestrel/administración & dosificación , Norgestrel/efectos adversos , Embarazo , Sri Lanka , SudánRESUMEN
This trial was designed to determine the differences in effectiveness, clinical acceptability, and one-year discontinuation rates of two low-dose oral contraceptives: Lo-Estrin (norethindrone acetate 1.5 mg plus ethinyl estradiol 0.030 mg) and Lo-Femenal (norgestrel 0.30 mg plus ethinyl estradiol 0.030 mg) in 148 Mexican women. In addition, the effects of both oral contraceptive preparations on blood lipids were prospectively evaluated in a subgroup of 41 women. The results indicated that there were no differences in pregnancy rates, discontinuation or clinical acceptability between the two groups. The lipid changes observed were minimal for the Lo-Femenal subgroup and somewhat greater for the Lo-Estrin group, mainly an increase in serum triglycerides. These changes were interpreted as estrogen induced effects of norethindrone-containing oral contraceptives. Overall, the data indicate that both Lo-Femenal and Lo-Estrin are effective and safe combined oral contraceptives.
Asunto(s)
Anticonceptivos Orales Combinados , Anticonceptivos Sintéticos Orales , Etinilestradiol , Noretindrona , Norgestrel , Adolescente , Adulto , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Orales Combinados/farmacología , Anticonceptivos Sintéticos Orales/efectos adversos , Anticonceptivos Sintéticos Orales/farmacología , Combinación de Medicamentos , Etinilestradiol/efectos adversos , Etinilestradiol/farmacología , Etinilestradiol/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Tablas de Vida , Lípidos/sangre , México , Noretindrona/efectos adversos , Noretindrona/farmacología , Norgestrel/efectos adversos , Norgestrel/farmacología , Aceptación de la Atención de Salud , Pacientes Desistentes del TratamientoRESUMEN
A non-randomized comparative clinical trial of the progestin-only oral contraceptive (POC), Ovrette (75 mcg norgestrel) (Wyeth), versus non-hormonal methods was conducted at two clinics in Buenos Aires, Argentina. The trial was designed to assess the breast-feeding patterns of women choosing progestin-only oral contraception and non-hormonal methods of contraception, and to study the relationship between lactation and the clinical performance of a POC. Five-hundred women were allocated to either the progestin-only pill group (n = 250) or to the non-hormonal group (n = 250) and were followed up monthly for six months after admission. Measurements in mean infant weight, mean infant length, and mean head circumference were similar throughout the follow-up period. Non-hormonal users reported significantly more self-perceived decreases in milk production at the 5th and 6th month follow-up intervals. Acceptance and continued use of the pill were excellent, with only one woman discontinuing because of a pregnancy which was attributed to user failure. The principal side effect reported by women in both groups was intermenstrual bleeding.
PIP: A nonrandomized, comparative, clinical trial of the progestin only oral contraceptive (OC) Ovrette (75 mcg norgestrel) vs. nonhormonal methods was conducted at 2 clinics in Buenos Aires, Argentina. The trial was designed to assess breast-feeding patterns of women choosing progestin- only OCs and nonhormonal methods of contraception and to study the relationship between lactation and the clinical performance of the OC. 500 women were allocated to either the progestin-only pill group (n=250) or t o the nonhormonal group (n=250) and were followed monthly for 6 months after admission. Measurements in mean infant weight, mean infant length, and mean head circumference were similar throughout the follow- up period. Nonhormonal users reported significantly more self-perceived decreases in milk production at the 5th an 6th month follow-up intervals. Acceptance and continued use of the pill were excellent, with only 1 women discontinuing because of a pregnancy which was the result of user failure. The principal side effect reported by women in both groups was intermenstrual bleeding.
Asunto(s)
Lactancia/efectos de los fármacos , Norgestrel/farmacología , Adolescente , Adulto , Argentina , Lactancia Materna , Dispositivos Anticonceptivos Femeninos , Femenino , Estudios de Seguimiento , Crecimiento/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Dispositivos Intrauterinos , Norgestrel/efectos adversosRESUMEN
This multicentric study was done in order to know the contraceptive efficacy and side effects of subdermal implants liberating levonorgestrel, in Mexican women. Results analysis, at one year, of 246 women, at four medical centers of Mexican Institute of Social Security (IMSS), showed that this contraceptive is highly efficacious, as there were no pregnancies in 2326 months of observation. The main side effects were: menstrual disorders in 34.8% of women; soreness in implantation site in 3.6%; headache in 13.4% and nausea, dizziness and vomiting in 11.6%. The most frequent causes for implant retirement were menstrual cycle alterations, and soreness at implantation site, with 7.3 and 3.5 respectively. The continuity rate at one year was 84.3, which was higher to what has been seen at the Institution with other temporal contraceptive methods, so the implants may be considered as one more alternative in family planning methods.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Norgestrel/administración & dosificación , Adulto , Anticonceptivos Femeninos/efectos adversos , Implantes de Medicamentos , Femenino , Cefalea/inducido químicamente , Humanos , Levonorgestrel , Trastornos de la Menstruación/inducido químicamente , Norgestrel/efectos adversos , Dolor/inducido químicamente , Aceptación de la Atención de SaludRESUMEN
This multicentric study was done in order to know the anticonceptive efficacy and side effects of subdermic implants liberating levonorgestrel, in Mexican women. Results analysis, at one year, of 246 women, at four medical centers of Mexican Institute of Social Security (IMSS), showed that this anticonceptive is highly efficacious, as there were no pregnancies in 2326 months of observation. The main side effects were: menstrual disorders in 34.8% of women; soreness in implantation site in 3.6%; headache in 13.4% and nausea, dizziness and vomiting in 11.6%. The most frequent causes for implant retirement were menstrual cycle alterations, and soreness at implantation site, with 7.3 and 3.5 respectively. The continuity rate at one year was 84.3, which was higher to what has been seen at the Institution with other temporal anticonceptive methods, so the implants may be considered as one more alternative in family planning methods.
Asunto(s)
Implantes de Medicamentos , Norgestrel , Cooperación del Paciente , Adulto , Implantes de Medicamentos/efectos adversos , Femenino , Humanos , Levonorgestrel , Norgestrel/efectos adversos , PielRESUMEN
The effectiveness of three drugs in controlling prolonged bleeding in the first year of NORPLANT implants use was tested. The drugs were levonorgestrel (L-Ng, 0.03 mg twice a day for 20 days), ethinylestradiol (EE, 0.05 mg per day for 20 days) and ibuprofen (Ib, 800 mg three times a day for 5 days) and were given orally. A control group received a placebo (PL, one pill of lactose for 20 days). Treatment should start each time a woman experienced eight consecutive days of bleeding or spotting. The 183 volunteers were not aware of the drug administered. A daily record of bleeding and spotting and of treatment intake was maintained. One-hundred-forty women completed the study period; 60 never used the prescribed treatment. Women treated with the three test drugs had significantly fewer bleeding and spotting days during the treated month and also throughout the study year than women using the placebo. The mean number of bleeding plus spotting days per actually treated subject in the first year was 77, 94, 101 and 129 days for the EE, Ib, L-Ng and PL groups, respectively. The administration of EE might help in the management of prolonged bleeding during the first year of NORPLANT implants use.
Asunto(s)
Anticonceptivos Femeninos/farmacología , Etinilestradiol/farmacología , Menstruación/efectos de los fármacos , Norgestrel/farmacología , Administración Oral , Adolescente , Adulto , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Orales/farmacología , Implantes de Medicamentos , Estudios de Evaluación como Asunto , Femenino , Humanos , Ibuprofeno/farmacología , Levonorgestrel , Norgestrel/efectos adversosRESUMEN
A non-comparative study of the progestogen-only oral contraceptive, norgestrel 0.075 mg, in breast-feeding women was conducted at the Centro de Investigaciones Regionales, Merida, Yucatan, Mexico. The study was designed to evaluate the overall acceptability and contraceptive efficacy of norgestrel in breast-feeding women. This report includes a survey of 200 women, all of whom were less than 26 weeks postpartum at admission; 113 were interval patients and 87 were postpartum. Follow-up visits were scheduled at 2, 6 and 12 months after admission. Overall, women experienced an increase in intermenstrual bleeding, amenorrhea, vaginal discharge and breast discomfort. The discontinuation rate at 12 months was 32.5 and the corresponding lost to follow-up rate was 22.5; this is a measure of acceptability. The 12-month life-table rate for pregnancy was 3.4 with a standard error of 2.0. Three women discontinued use of the mini-pill due to accidental pregnancy. One pregnancy was attributed to user failure and the woman conceived 9 months after entering into the study; the other two were attributed to method failure, one woman conceived 3 months after admission and the other conceived 6 months after admission.
Asunto(s)
Lactancia/efectos de los fármacos , Norgestrel , Adulto , Servicios de Planificación Familiar , Femenino , Estudios de Seguimiento , Humanos , Norgestrel/efectos adversos , Norgestrel/farmacología , EmbarazoRESUMEN
Se presentan los resultados de un estudio pre-introductorio clínico multicéntrico destinado a evaluar la eficacia, inocuidad y conducta de los nuevos implantes anticonceptivos Norplant en programas de salud pública de planificación familiar en Chile. El estudio fue realizado en seis clínicas (3 de Santiago y 3 de diferentes regiones) durante el período septiembre 1985 a junio 1988. Incluye 1.679 aceptantes con un total de 19.703 meses-mujeres de uso. Se realizó un total de 8.273 visitas de seguimiento con un promedio de 4,9 controles y 11,8 meses de observación por usuaria. Las tasas acumuladas de pérdida de seguimiento fueron bajas, 4,5% y 6,9% para el primer y segundo año de uso, respectivamente. Se registraron 6 embarazos, todos ellos durante el segundo año de uso. La eficacia anticonceptiva fue excelente y la tasa acumulada de embarazo fue de 0,0 a 12 meses y de 0,5 a 24 meses. La alteración de los patrones menstruales constituyó el efecto más frecuente y también la causa más importante de terminación. Fueron cerrados un total de 246 casos, 64 de ellos por problemas menstruales. Hubo 92 cierres por otras causas médicas. Un 31,2% de las usuarias no tuvo ningún problema o queja durante el período de observación. Las tasas acumuladas de continuación después de uno y dos años de uso fueron de 92,4 y 78,7 por cien mujeres, respectivamente. Los resultados sugieren que Norplan es un método anticonceptivo eficaz e inocuo, siempre que sea utilizado por personal de salud bien entrenado en consejería y en las técnicas de inserción y extracción
Asunto(s)
Embarazo , Adolescente , Adulto , Humanos , Femenino , Anticonceptivos Femeninos/efectos adversos , Implantes de Medicamentos , Planificación Familiar , Norgestrel/efectos adversos , Estudios de SeguimientoAsunto(s)
Hipertensión/etiología , Trastornos de la Menstruación/etiología , Norgestrel/efectos adversos , Administración Oral , Adolescente , Adulto , Presión Sanguínea/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Estudios de Evaluación como Asunto , Femenino , Humanos , Dispositivos Intrauterinos , Levonorgestrel , Norgestrel/administración & dosificación , Paridad , Vigilancia de Productos ComercializadosRESUMEN
Early chorionic activity was assessed in the premenstrual days by means of serum HCG beta-fraction. As control, a group of women with no contraceptive use was studied; early chorionic activity was detected in 31.8% of the cycles. In the group bearing an inert IUD the incidence was 20%, which did not differ from the control; while in the medicated IUD groups (Cu-IUD and LNG-IUD) the incidences were 4.8% and nil, respectively. Both medicated IUD groups showed a significant difference when compared with the control, as well as the inert IUD groups. The meaning of these findings, pointing out differences in the main mechanism of action between inert and medicated IUDs, is discussed.
PIP: Early chorionic activity was compared in 100 IUD users (inert device, copper IUD, and a levonorgestrel-releasing IUD) and 22 controls through measurement of the serum human chorionic gonadotropin (hCG) beta-fraction. In the control group, 7 (32%) of the 22 women had hCG beta-fraction values indicative of chorionic activity (i.e., 5mIU/ml). In the group of women wearing an inert IUD (Lippes Loop), 8 (20%) were positive for early chorionic activity. In contrast, the incidence of premenstrual chorionic activity signs was very low among women with medicated IUDs: 5% among acceptors of the copper IUD and zero among women in the levonorgestrel-releasing IUD group. In general, elevated premenstrual hCG values are indicative of failed implantation. The high incidence of hCG activity recorded among Lippes Loop acceptors in this study is consistent with the anti-implantation effect postulated for inert devices. In contrast, medicated IUDs appear to act by preventing rather than interrupting implantation and therefore should not be regarded as abortifacient contraceptive agents.
Asunto(s)
Corion/efectos de los fármacos , Gonadotropina Coriónica/sangre , Anticonceptivos Femeninos/efectos adversos , Dispositivos Intrauterinos de Cobre/efectos adversos , Dispositivos Intrauterinos Medicados/efectos adversos , Norgestrel/efectos adversos , Adulto , Anticonceptivos Femeninos/administración & dosificación , Femenino , Humanos , Levonorgestrel , Norgestrel/administración & dosificaciónRESUMEN
This report describes the long-term follow-up of 376 women who received NORPLANT implants in the period October 1974 through May 1979. One-hundred-and-ten subjects received replacement implants after variable lengths of use of the first set. The average levonorgestrel plasma levels declined steadily through eight years of use of NORPLANT capsules (r = -.937). Values were 0.35 ng/ml, 0.29 ng/ml and 0.22 ng/ml at treatment years 1, 5 and 8, respectively. Levonorgestrel plasma levels after replacement with a second set of implants were similar to those observed after the first insertion, either when placed in the same site as the first set or in a different area. Nineteen pregnancies occurred during 18,530 woman-months of use of the first set of implants, eleven of them during years 6 through 8 of treatment. The Pearl Index for the first 5 years of NORPLANT implants use was 0.63. No pregnancy has occurred in 4194 woman-months observed during treatment with a second set of capsules. Fifty-six women (14.9%) out of 376 acceptors of the first implant and 10 (9.1%) out of 110 acceptors of the replacement implants were terminated for other medical reasons, mainly bleeding problems and side effects commonly associated with hormonal contraception. Two women died while using NORPLANT implants, one of a cardiac arrest after surgery for a gallbladder disease and one because of endocranial hypertension originating from the rupture of an aneurism of the median cerebral artery. The bleeding pattern observed in the three months after NORPLANT capsules replacement was similar to that observed in the 90 days before replacement and different from that experienced by the same women in the first 90 days of implant use. This finding can be interpreted as an indicator of adaptive changes experienced by the target organs during long-term continuous administration of levonorgestrel. The prompt recovery of fertility after removal of NORPLANT implants suggests that these changes are reversible.
Asunto(s)
Norgestrel/sangre , Adulto , Femenino , Estudios de Seguimiento , Humanos , Levonorgestrel , Norgestrel/administración & dosificación , Norgestrel/efectos adversos , Cooperación del Paciente , Embarazo , Prótesis e Implantes , Elastómeros de Silicona , Factores de TiempoRESUMEN
A clinical trial of levonorgestrel-releasing Norplant implants used for contraception was undertaken in two cities in Colombia. Through two years in which 389 women had accumulated 594 years of use, there were no pregnancies. In a comparison group of copper intrauterine device acceptors, the one-year pregnancy rate was 1.1 per 100. Menstrual disturbances associated with progestin-only administration were the principal side-effects, and the major reason for cessation of use. Continuation among users of the implants was at the same or at a higher rate than observed among users of the intrauterine device. Advantages and disadvantages of alternate sites for implant placement are discussed.