SEARCH · PubMed Health

Results for “Administration, Intravaginal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources

PubMed2004

The combined contraceptive vaginal ring (NuvaRing) and lipid metabolism: a comparative study.

This study compared the lipid profile after three and six cycles of treatment with NuvaRing delivering 15 microg ethinylestradiol and 120 microg etonogestrel daily with a combined oral contraceptive (COC) containing ethinylestradiol 30 microg and levonorgestrel 150 microg. In the NuvaRing group 40 women were treated and 43 in the COC group. Compared with baseline, total cholesterol did not change in either group. NuvaRing did not affect HDL, but HDL, HDL2 and HDL3 levels decreased with the COC. In contrast, HDL2 increased with NuvaRing at cycle 3. LDL increased after cycles 3 and 6 with COC, and decreased after three cycles of NuvaRing treatment. Apolipoprotein A-1 levels increased with NuvaRing, but decreased with COC; apolipoprotein B and triglycerides increased, and lipoprotein(a) decreased in both groups. Sex hormone-binding globulin increased markedly more with NuvaRing, whereas corticosteroid-binding globulin levels increased less. These changes reflect the lower androgenicity of etonogestrel versus levonorgestrel and show that NuvaRing has a minimal effect on lipid profile.

Administration, Intravaginal↗

PubMed2004

A randomized comparison of sublingual and vaginal misoprostol for cervical priming before suction termination of first-trimester pregnancy.

This randomized trial compares the efficacy and side effects of sublingual and vaginal misoprostol for cervical priming before first-trimester pregnancy termination. One-hundred pregnant women between 6 and 12 weeks of gestation opting for termination of pregnancy by suction evacuation were included in this study. The women were randomly allocated into two groups. Group 1 received 400 microg of sublingual misoprostol and group 2 received 400 microg of vaginal misoprostol 2 h prior to suction evacuation. The abortion was carried out by suction evacuation using a Karman's cannula attached to an electrically operated suction machine under intravenous analgesia. Baseline cervical dilatation, duration of the procedure, operative blood loss, side effects and complications were noted in both groups. There was a significant difference between the sublingual and vaginal misoprostol groups with respect to mean cervical dilatation (8.6 mm vs. 6.8 mm, p < 0.05). However, the duration of the procedure (3.03 min vs. 3.16 min) and the amount of blood loss (29 mL vs. 31.2 mL) were not significantly different between the two groups. The women in the sublingual group experienced significantly more shivering and preoperative vaginal bleeding (68% vs. 56%, p < 0.05). None of the women in the two groups had either uterine perforation or excessive hemorrhage. In our study, sublingual misoprostol (400 microg) was significantly more effective in facilitating cervical dilation prior to surgical abortion than vaginal misoprostol.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Bioavailability of the Yuzpe and levonorgestrel regimens of emergency contraception: vaginal vs. oral administration.

Separate crossover studies compared the bioavailability of oral vs. vaginal routes of administration for the Yuzpe (n=5) and levonorgestrel regimens (n=4) of emergency contraception. Twice the standard dose of the Yuzpe regimen (200 microg of ethinyl estradiol, 1000 microg of levonorgestrel) or the levonorgestrel regimen (1500 microg of levonorgestrel) was self-administered vaginally. One week later, each subject received orally the standard dose of the assigned medication. Serial blood samples were collected over 24 h and assayed for levonorgestrel and ethinyl estradiol (for the Yuzpe regimen only). Paired t tests were used to compare oral vs. vaginal administration for maximum concentration (Cmax), time to maximum concentration (Tmax) and area under the curve over 24 h (AUC0-24). Relative bioavailability (vaginal/oral) was derived from AUC0-24. Vaginal administration of double the standard dose of the Yuzpe regimen resulted in a lower Cmax (vaginal=5.4 vs. oral=14.6 ng/mL, p=.038) and a later Tmax (5.9 vs. 2.0 h, p=.066) for levonorgestrel, compared to oral administration. Corresponding ethinyl estradiol concentrations were higher (786 vs. 391 pg/mL, p=.039) and peaked later (4.0 vs. 1.9 hr, p=.154) with vaginal administration. Relative bioavailabilities for levonorgestrel and ethinyl estradiol were 58% and 175%, respectively. Similarly, vaginal administration of the levonorgestrel regimen resulted in a lower Cmax (vaginal=5.4 vs. oral=15.2 ng/mL, p=.006) and a later Tmax (7.4 vs. 1.3 h, p=.037) for levonorgestel, compared to oral administration. The relative bioavailability was 62%. Our preliminary data suggest that vaginal administration of these emergency contraception regimens appears to require at least three times the standard oral dose to achieve equivalent systemic levonorgestrel concentrations.

Administration, Intravaginal↗

PubMed2005

Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study.

The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 mug oral and 400 mug vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n=40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6+/-1.5) and vaginal (mean, 7.2+/-0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4+/-0.2) and vaginal (mean, 3.6+/-1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients' pain perception and satisfaction mainly due to side effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

The effect of orally and vaginally administered misoprostol on inflammatory mediators and cervical ripening during early pregnancy.

OBJECTIVES: The objective of the present study was to investigate the effect of vaginally and orally administered misoprostol on the local cervical inflammatory response. METHODS: Healthy women with a normal intrauterine pregnancy between 8 and 12 weeks of gestation presenting for an elective termination of pregnancy by vacuum aspiration were recruited into a cohort study with a control and a treatment group. In the treatment group, the women were randomized to misoprostol, 400 mug, given either orally or vaginally 3 h before surgery. Immunohistochemistry staining of CD45, CD68, MMP 8, MMP 9, TIMP 1 and TIMP 2 were assessed in cervical biopsies obtained directly prior to mechanical cervical dilatation and vacuum aspiration. RESULTS: In the treatment group, there was a greater amount of CD45-positive cells in the subepithelium region of the cervix compared to the control group. The staining of CD68 was similar in both groups. The immunostaining of MMP 8 and MMP 9 was greater in the treatment group, while the expression of TIMP 1 and TIMP 2 did not differ between control and treatment groups. CONCLUSIONS: Compared to untreated controls, treatment with misoprostol was associated with a greater expression of inflammatory cells. It could be hypothesized that administration of misoprostol mimics the cervical ripening at term pregnancy by a possible influx and activation of inflammatory cells, which increases MMP 8 and MMP 9 and thereby leads to the degradation of collagen and cervical softening.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases.

DESIGN: A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation. METHODS: Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 microg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment. RESULTS: Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4-73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women. CONCLUSION: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Simultaneous very low dose mifepristone and vaginal misoprostol for medical abortion.

OBJECTIVE: This pilot study was designed to evaluate the outcome of medical abortion following simultaneous mifepristone (100 mg) and misoprostol (800 microg). METHODS: Enrollees had gestational ages up to 56 days and desired a medical abortion. They received 100 mg of mifepristone orally and 800 microg of misoprostol vaginally. Follow-up examination occurred in 2-7 days. A phone call 3 weeks later assessed symptoms and acceptability. A 95% success rate, as seen in higher dose studies, gives a 95% confidence interval of 88-100% for 40 subjects. RESULTS: Forty women were enrolled; 39 women had follow-up visits. Completed medical abortion was confirmed for 35 (90%) of 39 women. Four women had uterine aspiration. Two patients required repeat misoprostol. Median time from medication to abortion was 7 h. Most women (92%) strongly preferred taking all medications in the clinic. CONCLUSIONS: The simultaneous administration of vaginal misoprostol with 100 mg of oral mifepristone had the outcome of completed abortion within the predicted confidence interval. In addition, simultaneous dosing was highly acceptable.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

The pharmacokinetics and different regimens of misoprostol in early first-trimester medical abortion.

Misoprostol is a synthetic prostaglandin E(1) analogue that is commonly used for medical abortion. It can be given orally, vaginally and sublingually. A pharmacokinetic study has shown that sublingual misoprostol has the shortest onset of action, the highest peak concentration and the greatest bioavailability among the three routes of administration. Earlier clinical trials have shown that vaginal misoprostol is superior to oral misoprostol when combined with mifepristone for early first-trimester medical abortion. Recent studies on the clinical efficacy of sublingual misoprostol have demonstrated that it is as effective as vaginal misoprostol. Further studies are required to determine the optimal dose and route of administration of misoprostol that can give the highest complete abortion rate, lowest ongoing pregnancy rate and least side effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Studies on uterine contractility following mifepristone and various routes of misoprostol.

During pregnancy, uterine contractility is suppressed by progesterone. The progesterone receptor inhibitor, mifepristone, increases uterine contractility and sensitizes the myometrium to prostaglandin. The maximum effect is achieved when prostaglandins are administered 36 to 48 h after mifepristone. The recommended prostaglandin analogue used with mifepristone for medical abortion is misoprostol. It is licensed for oral use but other routes are used to improve efficacy. The difference in the effect of various routes of administration can be explained by pharmacokinetics and the effect on uterine contractility. Oral misoprostol leads to an increased uterine tonus without regular contractions. In contrast, vaginal and sublingual administration leads to a longer-lasting effect on the myometrium and subsequent development of regular contractions. Recently, a new oral slow-release preparation of misoprostol has been studied. Future studies will show whether prostaglandin analogues with a prolonged effect on the myometrium may further improve the regimens for medical abortion.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Review of medical abortion using mifepristone in combination with a prostaglandin analogue.

Induced abortion is still a major health problem in the world and the most frequently performed intervention in obstetrics and gynecology with an estimated total of 46 million worldwide each year. Medical abortion with mifepristone and prostaglandin was first introduced in 1988 and is now approved in 31 countries. This combination of drugs has recently been included in the List of Essential Medicines by the World Health Organisation. The present review summarizes the development, physiology and the development of the currently used regimens.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Sublingual versus vaginal misoprostol (400 microg) for cervical priming in first-trimester abortion: a randomized trial.

OBJECTIVE: Our objective was to compare the sublingual administration and the vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. DESIGN: We used an open, multicenter, randomized trial. LOCATIONS: We conducted the study in four clinics (in Valencia, Castelló, Murcia and Murcia Capital) in Spain. PARTICIPANTS: A total of 1424 healthy pregnant women with amenorrhea of <or=84 days who voluntarily decided to terminate their pregnancy participated in the study. METHODS: Women were randomly assigned to receive a single dose of 400 microg of misoprostol either sublingually or vaginally 1-3 h before aspiration. OUTCOME MEASURES: The outcome measures assessed were cervical dilation before surgery and surgical time needed for aspiration. The incidence of side effects, such as nausea, vomiting, diarrhea, fever/chills and paresthesia, was evaluated. RESULTS: The mean cervical dilation achieved was 6.8+/-0.8 and 6.7+/-0.9 mm for the sublingual and vaginal groups, respectively. The mean surgical time was 7.0+/-2.8 and 7.4+/-2.5 min for the sublingual and vaginal groups, respectively. Nausea, vomiting and diarrhea were more frequent in the sublingual group. CONCLUSIONS: Both regimens had equal efficacy; however, the sublingual route caused more side effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

The therapeutic role of estrogens in postmenopausal women.

This article reviews the history and present use of estrogens for the treatment of menopausal symptoms. It includes management of several different cases, including a review of all estrogens and estrogen/progestin preparations available in the United States.

Administration, Intravaginal↗

PubMed2004

Does the route of administration of misoprostol make a difference? The uterotonic effect and side effects of misoprostol given by different routes after vaginal delivery.

OBJECTIVE: To compare the postpartum uterotonic effect and side effects of misoprostol administered by different routes. STUDY DESIGN: Fifty women were given misoprostol 400 microg either by the oral solution, oral tablet, rectal or vaginal route, or intramuscular syntometrine 1 ml after spontaneous vaginal delivery. Pre- and post-treatment uterine activity were measured with intrauterine pressure catheters. RESULTS: Uterine activity produced by oral solution misoprostol 400 microg was significantly higher than that of oral tablet, rectal and vaginal misoprostol (P = 0.004, 0.002, respectively). Onset of action after oral solution misoprostol was faster than by the oral tablet (P = 0.01), rectal (P < 0.001) and vaginal (P< 0.001) routes. Shivering and pyrexia were most common with oral solution misoprostol. Maximum body temperature recorded was significantly higher with oral solution misoprostol than with oral tablet, rectal and vaginal misoprostol (P = 0.009, 0.001, respectively). CONCLUSION: Different routes of administering misoprostol greatly influence the effects achieved. Oral solution misoprostol produces the fastest and strongest uterotonic effect, with the most side effects.

Administration, Intravaginal↗

PubMed2005

A comparison of oral and vaginal misoprostol for induction of labor.

OBJECTIVE: The aim of the study is to compare the efficacy and safety of oral (100 microg) and vaginal (50 microg) misoprostol for labor induction. STUDY DESIGN: Ninety-nine patients with indications for labor induction randomly received 100 microg oral misoprostol every 4 h or 50 microg vaginal misoprostol every 4 h, using maximum six doses. Mean induction to delivery interval, mode of delivery, rates of tachysystole, hypertonus and hyperstimulation syndrome, oxytocin use, number of doses used, failed induction rate and neonatal outcomes were compared for the two groups. RESULTS: Mean dose of misoprostol used for oral and vaginal misoprostol groups were 2.17+/-1.35 and 1.91+/-0.94, respectively (p=0.65). There were two failed inductions in the oral (4%) and one failed induction (2.5%) in the vaginal group after a total of six doses of misoprostol (p=0.58). There was no significant difference for the mean induction to delivery interval, to the beginning of active phase interval, active phase duration, second stage duration and the number of women who received oxytocin for induction or augmentation between the two groups (p>0.05). There were also no significant differences for intrapartum complications and neonatal outcomes between the oral and vaginal misoprostol groups (p>0.05). CONCLUSION: Our findings indicate that, in a closely supervised hospital setting with adequate monitoring, 100 microg oral misoprostol has the potential to induce labor as safely and effectively as its 50 microg vaginal analogue. As oral use of the drug is easier for both the patient and the doctor, oral misoprostol will probably be more preferable than the vaginal route.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Sublingual versus vaginal route of misoprostol for cervical ripening prior to surgical termination of first trimester abortions.

BACKGROUND: Sublingual and vaginal routes of misoprostol have been found to be effective for pharmacological ripening prior to surgical termination of first trimester abortions. We conducted this study to compare the effectiveness and acceptability of sublingual versus vaginal route of misoprostol for cervical priming prior to vacuum aspiration (VA). METHODS: In this prospective clinical trial, a total of 100 women with period of gestation between 6 and 12 weeks scheduled for day surgery abortion were sequentially allocated into two groups of 50 each. All participating women received 400 microg of misoprostol 3 h prior to VA either by sublingual (self-administered at home) or by vaginal route (inserted by the doctor in hospital) after wetting the tablet with water. RESULTS: Demographic characteristics of both the groups were comparable. For all periods of gestation, sublingual misoprostol significantly improved cervical dilatation (p<0.001) and reduced the time duration of surgery (p<0.001) compared to vaginal group without increasing the side effects. Mean pain score of the sublingual group was 2.7+/-1.1 as compared to 3.2+/-1.6 of the vaginal group (p=0.57). Misoprostol tablet was found intact in the vagina of three patients and was only partially absorbed amongst five patients at the time of VA. CONCLUSION: Sublingual route is an effective and convenient alternative to vaginal administration of misoprostol for cervical dilatation. It can be conveniently self-administered at home thereby decreasing hospital stay and cost. It also has a good patient acceptability rate.

Abortion, Induced↗

PubMed2005

Pharmacokinetics and endometrial tissue levels of levonorgestrel after administration of a single 1.5-mg dose by the oral and vaginal route.

OBJECTIVE: To determine the pharmacokinetics and endometrial tissue levels of levonorgestrel when taken as a single dose of 1.5 mg either orally or vaginally by healthy women in the periovulatory phase of their menstrual cycle. DESIGN: Prospective randomized study. SETTING: Academic research institution. PATIENT(S): Thirty women with regular cycles allocated to control (n = 5), oral (n = 13), and vaginal (n = 12) groups. INTERVENTION(S): Blood samples were drawn before (0 time) and at 0.5, 1, 2, 4, 6, 8, 24, 48, and 168 hours after levonorgestrel administration. Endometrial samples were collected 24 and 168 hours after levonorgestrel administration. MAIN OUTCOME MEASURE(S): Plasma and endometrial tissue levels of levonorgestrel. RESULT(S): Plasma concentrations of levonorgestrel were significantly greater during the first 48 hours after oral administration. However, 7 days after levonorgestrel administration, the plasma levels were similar for both treatments (3-5 nmol/L). Compared with vaginal administration, oral administration resulted in higher peak plasma concentrations (Cmax 64 vs. 10.7 nmol/L), with a shorter time to reach the maximal concentrations (Tmax 1.4 vs. 6.6 hours) and with a greater AUC (509 vs. 175 nmol/L). Interestingly, the half-life of levonorgestrel was shorter after oral administration (25 hours vs. 32.6 hours). Levonorgestrel tissue concentrations were not related to the plasma levels. Levonorgestrel values tended to be higher in endometrial tissue after vaginal administration. The ratio between plasma and endometrial concentrations of levonorgestrel differed significantly between the groups. CONCLUSION(S): These data indicate that orally administered levonorgestrel achieves higher plasma levels sooner than vaginally administered levonorgestrel. However, plasma levels after vaginal administration are more sustained and were likely to be sufficient for ovarian suppression. Therefore, the vaginally administered levonorgestrel could be considered as an alternative option for emergency contraception.

Administration, Intravaginal↗

PubMed2005

Comparison of vaginal and oral administration of emergency contraception.

OBJECTIVE: To compare the physiologic effects of vaginally and orally administered emergency contraception. DESIGN: Prospective, open-label, crossover study. SETTING: University research center. PATIENT(S): Nine regularly menstruating volunteers. INTERVENTION(S): Five subjects received 1,000 microg of levonorgestrel with 200 microg of ethinyl E2 (twice the standard Yuzpe regimen dose) vaginally, and the standard Yuzpe regimen dose orally 1 week later. Four subjects received 1,500 microg of levonorgestrel (twice the standard Plan B regimen dose) vaginally and received the standard Plan B dose orally 1 week later. Serum samples were obtained at baseline and at frequent intervals after each dose. MAIN OUTCOME MEASURE(S): Serum gonadotropin, hepatic globulin, and androgen levels measured at baseline, at the time of peak levonorgestrel, and 24 hours later. RESULT(S): Gonadotropin, hepatic globulin, and androgen levels were suppressed to a similar degree among the four regimens, with a return to baseline levels after 24 hours. CONCLUSION(S): We conclude that high doses of levonorgestrel found in emergency contraception regimens lead to a transient direct suppression of gonadotropin, hepatic globulin, and androgen levels. This effect is similar after vaginal and oral administration of emergency contraception. Therefore, the vaginal route of administration of emergency contraception regimens may be as efficacious as the oral route.

Administration, Intravaginal↗

PubMed2006

A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women.

OBJECTIVE: To compare the effects of oral and vaginal estrogen therapy (ET) on the lower urinary tract in postmenopausal women with prior hysterectomy. DESIGN: Randomized, prospective study. SETTING: Tertiary teaching hospital. PATIENT(S): Fifty-seven hysterectomized, postmenopausal women. INTERVENTION(S): Patients were randomized to receive either oral (0.625 mg of conjugated equine E per tablet; n = 27) or topical (0.625 mg conjugated equine E per 1 g vaginal cream; n = 30) E, administered once daily. MAIN OUTCOME MEASURE(S): All subjects had E2 measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews with the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 3 months after ET. RESULT(S): A higher serum level of E2 was noted in the oral group compared with the topical group after ET. The post-ET pulsatility index of periurethral vessels and bladder neck revealed statistically significant decreases in both groups. The incidences of urinary frequency and nocturia were significantly decreased after 3 months of ET in both groups. Changes in the incidence of other symptoms, including stress incontinence and urge incontinence, were not statistically significant. However, subjective improvement of stress incontinence was found in 72.7% of the oral group and 60% of the topical group. CONCLUSION(S): The results suggest that ET alone, by an oral or vaginal route, could increase the blood flow around the bladder neck and mid-urethra and relieve the symptoms of overactive bladder and stress incontinence in postmenopausal women with prior hysterectomy. In addition, vaginal preparations are as effective as systemic therapy at the lower serum level of E2.

Administration, Intravaginal↗