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At least 127 records · Page 7Linked to original sources

PubMed2006

Combined oral contraception in women after renal transplantation.

AIM: To assess safety of combined low-dose oral contraceptives in women after renal transplantation. MATERIAL AND METHODS: Twenty six female renal graft-recipients, aged from 18 to 44 (mean 31 years), who used combined low-dose oral contraceptives after renal transplantation for at least 18 months were enrolled in the study. All patients had stable graft function with mean serum creatinine of 1.3 mg/dl. In 58% of women effective contraception was the mean indication for the therapy, in the remaining group pills were indicated additionally for the development of ovarian cysts and excessive menstrual bleedings. Ethinyl estradiol dose was 20 mug in 73% of cases and 30-35 microg in the remaining group. RESULTS: No case of pregnancy was observed. Contraceptive therapy was discontinued in two cases: for profound vein thrombosis in one and deterioration of liver function in the other case. No side effects of contraceptives were observed in the remaining group of patients within at least 18-month observational period. No case of ovarian cyst was reported. Oral contraceptives were not found to influence body mass index (BMI), mean blood pressure, serum creatinine and biochemical parameters (AST, ALT, total bilirubin, glucose and cholesterol). CONCLUSIONS: Despite the presence of relative contraindications for hormonal drugs (arterial hypertension and deteriorated liver function) in female renal recipients, administration of combined low-dose contraceptive pill should be taken into account as highly effective contraceptive method, that additionally regulates menstrual bleeding patterns, protects from ovarian cysts development and improves life quality of the patient.

Adolescent↗

PubMed1997

The HSD-hCG vaccine prevents pregnancy in women: feasibility study of a reversible safe contraceptive vaccine.

PROBLEM: To develop a vaccine for reversible control of fertility in women. MATERIALS AND PROTOCOLS: Purified beta subunit of hCG annealed to purified alpha subunit of ovine LH linked chemically to tetanus toxoid (TT) and diphtheria (DT); vaccine employed at 300 micrograms gonadotropin equivalent per injection adsorbed on alhydrogel with 1 mg SPLPS added in the first injection; Phase I safety trials in 47 women with elective tubal ligation; Phase II efficacy studies in 148 proven fertile women (2 children), sexually active, desirous of family planning using IUD; IUD removed when anti-hCG titres exceed 50 ng/ml hCG bioneutralization capacity; boosters given to maintain above threshold antibody levels; post coital tests conducted in 8 volunteers; sera of protected women analysed for immuno-determinants recognized by competitive enzyme immunoassays employing a panel of monoclonal antibodies and by direct binding to synthetic peptides; recombinant vaccines expressing beta hCG as a secreted product or as a fused protein anchored on membrane. RESULTS: Immunization was well tolerated with no significant changes in endocrine, metabolic and hematological indices. Normal ovulatory cycles were maintained as indicated by menstrual regulation. The vaccine was highly effective in preventing pregnancy (1 pregnancy in 1224 cycles ) at and above antibody titres of 50 ng/ml. Antibodies declined in course of time in absence of boosters, with conceptions occurring below 35 ng/ml titres indicating regain of fertility. Ability of antibodies to prevent pregnancy was confirmed by post coital tests. High avidity (10(10) M-1) and other characteristics of antibodies generated by the vaccine are described and compared with those induced by two other hCG vaccines having undergone Phase I trials. The antibody response of the HSD vaccine in humans is characterized predominantly to an epitope recognized by the monoclonals 206 and P3W80. The antibodies had low or no reactivity with the carboxy terminal peptide and 38-57 region peptide. Live recombinant vaccines expressing beta hCG as a membrane anchored peptide generated antibody response to hCG in all animals following a single injection. CONCLUSIONS: Reversible fertility control is feasible with the HSD-hCG vaccine without impairment of ovulation or disturbance of menstrual regularity. Suggestions have been made for further optimization of the vaccine, which include replacement of TT and DT by a panel of T non B determinants communicating with the entire MHC spectrum and development of recombinant vaccine expressing beta hCG along with membrane anchored carrier.

Animals↗

PubMed1986

Evaluation of a new triphasic oral contraceptive in private practice.

We evaluated the clinical and metabolic effects of a new triphasic regimen developed in the continuing attempt to reduce the dose of estrogen and progestogen in oral contraceptives. A combination of ethinyl estradiol (EE) and levonorgestrel (LNg) was used (six tablets with 30 micrograms EE + 50 micrograms LNg, five tablets with 40 micrograms EE + 75 micrograms LNg, and 10 tablets with 30 micrograms EE + 125 micrograms LNg), also known as Triphasil (Wyeth). In a private practice, 409 subjects participated in 7,286 treatment cycles. Three pregnancies occurred, all due to subject failure. Menstrual regulation was excellent and the incidence of side effects extremely low. Withdrawals from the study for possibly drug-related medical reasons totaled 9.0% through 56 cycles of treatment. Metabolic changes also were evaluated in 14 of these women over a 6-month period. The only statistically significant increase in carbohydrate values occurred at 6 months. The mean glucose level at 30 minutes of the oral glucose tolerance test was above the baseline mean value, but serum insulin levels showed no statistically significant deviation. Lipid values presented are total lipids, total cholesterol, triglycerides, alpha-, beta-, and pre-beta-lipoproteins, and high density and low density lipoprotein cholesterol. There was no statistically significant difference between the mean values at baseline and those during treatment for any lipid variable. These results indicate that this triphasic oral contraceptive has a high degree of efficacy, a low incidence of side effects, excellent cycle control, and high subject compliance, and would seem to indicate a minimal influence on the metabolism of lipids and carbohydrates in the small number of subjects studied.

Blood Glucose↗

PubMed1985

Contragestion by antiprogestin: a new approach to human fertility control.

The steroidal derivative RU 486 (17 beta-hydroxy-11 beta-(4-dimethylaminophenyl 1)-17 alpha (prop-1-ynyl)-estra-4,9-dien-3-one) is the first potent antiprogestin. Acting reversibly at the molecular level of receptor binding, it interrupts progesterone action definitively if the target cell dynamics are irreversibly disrupted. Its preferred target cells are those of the uterine decidualized mucosa and uterine cervix, and increased myometrial contractility facilitates the termination of pregnancy. Luteolysis is secondary to the decrease in chorionic gonadotropin, itself brought about by secondary alteration or detachment of the trophoblast. Clinical results so far indicate that RU 486 can be a very efficient and safe contragestive agent, especially for the medical termination of early pregnancy or as a postcoital menses inducer or menstrual regulator. Incomplete expulsion is sometimes noted at present when RU 486 is given alone but this may not happen when efficient form(s) of administration are used and/or when uterotonics are added. When a small amount of prostaglandin (which by itself would be inefficient) is given at the end of treatment with RU 486, the results are highly satisfactory. The antiprogestin RU 486 does not expose women to hormones continuously. Based on a dual concept, physiological and molecular, it may be typical of the second generation of agents required to achieve safe and effective control of human fertility.

Abortifacient Agents↗

PubMed1987

Contragestion by antiprogestin RU 486: a review.

The steroidal derivative RU 486 (17 beta-hydroxy-11 beta-(4-dimethyl-aminophenyl 1)-17 alpha-(prop-1-ynyl)-estra-4,9-dien-3-one) is the first potent antiprogestin in medical use. Acting reversibly at the molecular level of receptor binding, RU 486 blocks progesterone action and allows endocrine functions to return quickly to normal after its use. However, target cells dynamics that depend upon a continuity of progesterone action will be irreversibly disrupted. In normal women RU 486 acts during the luteal phase in the endometrium, provoking bleeding, and also decreases LH secretion which results in luteolysis. In pregnant women, if affects the decidual, increases myometrial contractility and ripening of the cervix, and ultimately leads to termination of pregnancy. Detachment of the trophoblast leads to a fall in chronic gonadotrophin. Clinical studies indicate that RU 486 can be a very efficient agent for the termination of early pregnancy, and as a postcoital menstrual regulator. The failures observed when RU 486 is given alone may be overcome by the additional use of oxytocics. A small amount of prostaglandin given at the end of RU 486 treatment gives satisfactory results at up to 8 weeks of amenorrhea. Treatment with RU 486 is short term, and apparently has no significant side-effects despite the compound's antiglucocorticosteroid activity.

Abortifacient Agents↗

PubMed1980

Pelvic infections following gynecologic procedures in Bangladesh.

Data were collected to establish the rate of pelvic infection following various gynecologic procedures, including postpartum intrauterine device (IUD) insertions, IUD insertion following menstrual regulation procedures, IUD insertion in women who were not recently pregnant, and induced and spontaneous abortions. The pelvic infection rate was only 1% in 97 women who underwent postpartum IUD insertions. The infection rate was related to the timing of IUD insertion and the type of IUD used. Finally, the pelvic infection rate was unacceptably high (10.3%) in women undergoing induced abortions vs. women having spontaneous abortions (1.1%).

Abortion, Induced↗

PubMed1984

Termination of very early pregnancy by RU 486--an antiprogestational compound.

RU 486, a new antiprogestational compound, was given to 37 women seeking termination of pregnancy and with amenorrhea of 42 days or less. One patient was found at the second follow-up visit to have an extrauterine pregnancy. The patients received either 25 mg, 50 mg or 100 mg RU 486 twice daily for four days. All patients attended three follow-up visits, one, two and five to six weeks after the start of therapy. The start, duration and amount of bleeding as well as plasma progesterone, beta-hCG and cortisol concentrations were determined for each treatment day and at the follow-up visits. All patients but three started to bleed during treatment. Frequency of complete abortion was 61% (22 out of 36 patients). In only three patients was the pregnancy unaffected by treatment. The clinical efficacy of the treatment was not dose-dependent. Most of the patients experienced only minor side effects in terms of mild uterine pain, nausea and vomiting. However, two patients suffered from heavy bleeding requiring blood transfusion and curettage. In the patients with complete abortion, beta-hCG values decreased significantly but not until the first follow-up visit. The plasma progesterone also decreased. The decrease appeared earlier with the higher daily dose of RU 486. Cortisol concentrations increased during treatment with all 3 dosage regimens but the levels remained within the normal range. It is concluded that treatment with RU 486 may provide a novel therapy for "menstrual regulation" but the efficacy of the treatment needs to be improved to compete with alternatives such as vacuum aspiration.

Abortifacient Agents↗

PubMed1986

Plasma levels of antiprogestin RU 486 following oral administration to non-pregnant and early pregnant women.

RU 486 is a synthetic steroid which acts as an antiprogestin at the receptor level. The clinical usefulness of the compound for menstrual regulation and termination of early pregnancy is currently being evaluated. The aim of the present study was to determine the plasma levels of RU 486 following the oral administration of the compound to 42 pregnant and 10 non-pregnant women. The levels of RU 486 were measured by a radioimmunoassay method which uses chromatography on Sephadex LH 20 columns. The identity of the compound assayed as RU 486 was confirmed, but the presence of small amounts of two highly cross-reacting metabolites (monodemethyl and didemethyl RU 486) in the analyzed fractions could not be excluded. Following the ingestion of a single tablet containing 25 and 50 mg of the compound, a peak plasma value of approximately 3.5 to 4.0 mumol/l in both the pregnant and non-pregnant subjects was reached one to two hours later. The half-lives of elimination were about 20 hours in both the pregnant and the non-pregnant women. Following the repeated oral administration of 50, 100 or 200 mg of RU 486 daily for four days, maximum plasma levels of 2.9, 4.5 and 5.4 mumol/l, respectively, were found. Thus, the increase in plasma levels was not directly proportional to the increase in the dose. No accumulation of RU 486 in the plasma was found, even when the duration of treatment was prolonged to six days. The data partly explain the reported lack of relation between ingested dose and frequency of induced abortion and they may be useful for designing future studies on the use of compound to prevent implantation, induce menstruation or terminate an early pregnancy.

Abortifacient Agents↗

PubMed1991

A pilot study of acceptability of RU486 and ONO 802 in a Chinese population.

RU486 and ONO 802 in combination have been shown to be effective in early termination of pregnancy. Anecdotal information suggests that Chinese women have been using herbs to induce abortion, believing that such medication and means of abortion is less harmful to the body than surgery. Hence, a medical means of abortion using RU486 and ONO 802 may be the method of choice for some Chinese women. A pilot study involving 42 Chinese women in Hong Kong was conducted to explore the reasons for acceptance or refusal of RU486 and ONO 802 as abortifacient agents. It was found that more single women chose the medical method for abortion, the main reasons being fear of trauma to the body due to surgery and the feeling of having undergone menstrual regulation rather than having had an abortion with the medical method. Those who refused the treatment were worried about the efficacy and side effects of the new drugs and the long induction-abortion interval. There were 3 failures in the medical group of 23 women. All these 23 women were gland they had chosen the medical abortion method. Twenty-one out of the 23 women said they would choose the same abortion method again. The practice of the use of Chinese herbs was not more common in this group of women as compared to women who did not choose this method of abortion.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

Use of erythromycin for nonsurgical female sterilization in West Bengal, India: a study of 790 cases.

OBJECTIVE: Determine if erythromycin is an effective agent for achieving occlusion of the Fallopian tube for nonsurgical female sterilization. METHODS: Two studies of 100 healthy volunteers requesting sterilization were planned, one in Julpia Andhermanik and the other in Kolkata (Calcutta). A readily available marketed tablet preparation containing 500 mg of the estolate salt of erythromycin was used for the trial. In one study (Bishnupur), the tablet was crushed before placing in a copper-T IUD inserter for placement at the fundus. In the other study (Kolkata), crushed tablets were processed into 50 mg pellets of the same diameter as standard quinacrine pellets and 10 pellets were inserted at the fundus using aseptic precautions. Procedures in each study were repeated at 30 days. Oral contraceptives were prescribed for three cycles following first insertion. No incentive was offered for participation in the trial. Follow-up treatment, including first-trimester abortion for pregnancy due to failure of the sterilization procedure, was assured without charge. Due to extraordinary patient demand, one study (Bishnupur) was expanded to 690 cases for reasons of compassion. RESULTS: At 12 months of use, the failure rate of the sterilization procedure for the crushed 500 mg tablets was 35.8% (SE = 1.8) with 417 women at risk. At 12 months of use, the failure rate for the erythromycin pellets was 28.6% (SE = 5.0) with 43 women at risk. There were no serious complications reported in either trial. All pregnancies resulting from failure of the sterilization procedure were terminated by menstrual regulation within 10 weeks gestation. CONCLUSIONS: The failure rate in this study is unacceptably high for erythromycin to be used as a sterilization method.

Erythromycin↗

PubMed2001

Quinacrine sterilization in Tripura, India.

A 611-case clinical trial of quinacrine sterilization (QS) was conducted at Agartala, Tripura State, India, using a unique protocol. No pregnancy failures were reported after a mean of 45.8 months of follow-up. Three trans-cervical insertions of 324 mg, 288 mg, and 252 mg quinacrine pellets were used in the first, second, and third insertions, respectively. Insertions were done on Days 6-10 of the menstrual cycle with the women remaining in a slight Trendelenberg position for 2 h post insertion. Antibiotics were prescribed after each insertion, and 3 months' supply of an additional contraception provided from first insertion. A unique inducement to report pregnancy failures was employed. Each woman was offered the equivalent of 5 months' family income to report any pregnancy following QS and a free menstrual regulation procedure. No pregnancies were reported. An independent follow-up visit to a systematic sample of 40 women found no pregnancies.

Female↗

PubMedDate not supplied

The use of progesterone antagonists and progesterone receptor modulators in contraception.

Progesterone antagonists (PAs) and progesterone receptor modulators (PRMs) have contraceptive potential by suppressing follicular development, delaying the surge of luteinizing hormone (LH), retarding endometrial maturation, and promoting endometrial bleeding. Mifepristone, in daily doses of 2-10 mg, blocks the LH surge and ovulation. Many of the studies were conducted in women not at risk of pregnancy, and thus the contraceptive efficacy is not yet known. Nevertheless, there is evidence that daily doses of 2 or 5 mg of mifepristone have contraceptive potential. Because of anovulation, there may be an unopposed estrogen effect on the endometrium, although this risk may be mitigated by the noncompetitive anti-estrogenic activity exhibited by both PAs and PRMs. Low doses of PAs and PRMs, which do not affect ovulation, retard endometrial maturation, indicating that the endometrium is exquisitely sensitive to these compounds. This raises the prospect of endometrial contraception, i.e. prevention of endometrial maturation without disturbing ovulation or producing alterations in bleeding patterns. This approach works well in monkeys but was not found to be very promising when given to women not using contraception. On the other hand, 200 mg mifepristone administered 48 h after the LH surge, which has minimal or no effect on ovulation and bleeding patterns, is an effective contraceptive; yet, it is not a practical approach to contraception. Late luteal phase administration of mifepristone produces menstrual bleeding. However, when mifepristone was administered every month at the end of the cycle either alone or together with prostaglandins, it was not very effective in preventing pregnancy. In contrast, a mifepristone-prostaglandin combination has been shown to be a very effective treatment for occasional menstrual regulation, with vaginal bleeding induced in 98% of pregnant women, with menses delay of 11 days or less. Mifepristone is an excellent agent for emergency contraception when used within 120 h of unprotected intercourse. It is also possible that PAs and PRMs may be used to reduce the occurrence of bleeding irregularities induced by progestin-only contraceptive methods. Both classes of progesterone receptor ligands may also have contraceptive efficacy by having a pharmacological effect on the embryo or altering tubal transport or other aspects of tubal physiology.

Animals↗

PubMed1981

Complications from induced abortion in Bangladesh related to types of practitioner and methods, and impact on mortality.

Health-workers in 795 health centres in Bangladesh were interviewed about complications arising from induced abortion in rural Bangladesh. 1590 cases of complications from abortion were reported. Dais (traditional birth attendants) and traditional practitioners were the larger groups of operators (42.1% and 18.1%, respectively). Menstrual regulation or dilatation and curettage (the medically approved procedures) were used 9.1% of the time. Nearly half the complicated abortions were induced by inserting a foreign object, such as a stick or root (sometimes treated with an herb), into the uterus and leaving it until either abortion or complications ensued. 498 abortion-related deaths were reported. The proportion of complicated abortions resulting in death was lowest for medically approved procedures (4.9%) and highest for vigorous physical activity (100%) and abdominal pressure (66.7%), although the last two together accounted for only 2.3% of abortion procedures. Women who died after abortion were more likely than were women who survived to be further along in their pregnancies. An extrapolation from these results gives a figure of 780000 abortions in Bangladesh in 1978 and 7800 deaths that year from abortion complications. Many of these deaths might have been prevented if a means of safe, affordable termination of unwanted pregnancy had been available.

Abortion, Induced↗

PubMed1999

Tetanus and pregnancy-related mortality in Bangladesh.

A national survey of health-care providers in Bangladesh identified 298 women who died from pregnancy-related tetanus. Immunising all girls with tetanus toxoid and providing safe menstrual regulation services would prevent such deaths.

Abortion, Induced↗

PubMed2001

Neuromodulation in polycystic ovary syndrome.

Although central and peripheral factors have been implicated in the neuromodulation of GnRH in PCOS, there are no definitive or conclusive data to establish a primary causal role for any one factor. Because increased GnRH pulse frequency is at least a contributor to the secretion of excess LH and insufficient FSH that are the proximate cause of chronic anovulation in PCOS, strategies to slow the GnRH pulse generator are likely to promote ovulation in women with PCOS. Several pharmacologic agents, such as dopamine agonists and antagonists, have been tried, but the lack of consistent effects in women with PCOS limits their clinical utility. Current treatment strategies include the use of the combined oral contraceptive pills, antiandrogens or androgen receptor blockers, and insulin sensitizers. Oral contraceptive preparations are effective in suppressing ovarian hyperandrogenemia, regulating menstrual cycles, and reducing the risk of endometrial hyperplasia. Androgen blockade and antiandrogens provide symptomatic relief from androgen-induced acne and hirsutism and have been reported to restore ovulation in women with PCOS. Whether this effect is mediated peripherally or centrally remains to be clarified. The most recent class of pharmacologic agents to gain popularity are the "insulin modifiers." With increasing evidence that insulin resistance constitutes a key metabolic element, it seems logical that improving insulin sensitivity and glucose disposal might wholly, or partially, reverse certain features of PCOS, including anovulation. To date, insulin modifiers have proved most promising in improving the clinical features and promoting fertility, but whether this effect is centrally mediated is yet to be elucidated.

Female↗

PubMed2005

Availability and acceptability of medical abortion in Nepal: health care providers' perspectives.

Abortion was legalised in Nepal in September 2002 and manual vacuum aspiration is the main procedure used for safe abortion. Although medical abortion has not yet officially been introduced in Nepal, with the highly porous Indo-Nepal border and the easy availability of mifepristone and misoprostrol in Indian chemists' shops, it is possible the drugs are entering from Indian markets illegally. This study aimed to gauge current awareness of the availability of medical abortion drugs in Nepal and explore what health professionals and paramedics felt about the use of medical abortion to expand access to safe abortion in the country. Data were drawn from interviews with private obstetrician-gynaecologists, general physicians, paramedics, ayurvedic and homeopathic practitioners and chemists in 24 urban municipalities and peri-urban areas in Nepal. Various types of allopathic and indigenous forms of medicine for menstrual regulation in the Nepalese market were widely known whereas knowledge of the availability of mifepristone and misoprostrol was low. Almost all respondents had a positive view of the potential for providing mifepristone and misoprostol in Nepal and most thought that obstetrician-gynaecologists, general physicians and other certified abortion care providers should be able to provide the drugs. Many respondents were interested in doing so themselves. Registration of mifepristone and misoprostrol is the key to introducing medical abortion in Nepal and should happen as soon as possible.

Abortifacient Agents, Nonsteroidal↗

PubMed1993

[Gestagen-estrogen combinations in gynecology. On the history, dosage and use of a hormone principle].

The first experimental and clinical investigations with gestagen-oestrogen combinations were undertaken in the late 'forties and the early' fifties of this century. In the course of further research and development, the dosage and mixture ratio of this hormonal principle were adjusted, according to the physiological status of the corpus luteum phase and its imitation by means of administration of hormonal doses. Considering the relatively large individual variations, an average daily production of 0.05 mg oestradiol/oestrone and 25 mg progesterone can be assumed, the mixture ratio being 1:50. Further indicators for the dosage were obtained by studying the biological valency of the semi-synthetic substances on the basis of the following parameters: transformation dose, menstruation delay test, anti-oestrogenic effectiveness and ovulation inhibition dose. Finally, dosage was also determined by the relevant indications; in this respect, depending on the intended use, preparations with the emphasis either on the oestrogen component or the gestagen component were deliberately produced. Up to the end of the 'fifties', parenteral gestagen-oestrogen combinations were the only preparations available for gynaecological hormonal therapy. Oral medication was predominant from 1957 onwards. The high ranking achieved by the combination preparations was due to their properties with respect to regulating menstrual haemorrhage and inhibiting proliferation and ovulation, as well as to their antiandrogenic properties. As far as methods of application were concerned, cyclical administration was most frequently employed (including phase variants), therapeutic amenorrhoea being second, whereas high-dosage application in the sense of hormonal pseudopregnancy was less often used. The gestagen-oestrogen combinations have become the most important hormonal principle in gynaecology as therapeutic agents and hormonal contraceptives.

Contraceptives, Oral, Combined↗

PubMed2005

Knowledge, attitudes and practices regarding emergency contraception among family-planning providers in Turkey.

OBJECTIVE: The research was planned descriptively to define the knowledge, attitudes and practices of family-planning providers regarding emergency contraception. METHODS: The sample included 21 Maternal-Child Health/Family Planning Centers located in the European region of Istanbul, and the research was conducted with 41 family-planning providers employed in these facilities. RESULTS: All of the family-planning providers were aware of emergency contraception, 82.9% accurately defined emergency contraception, 61% stated that emergency contraception was legal, and 53.7% expressed that it could be employed in rape indications. All the family-planning providers (100%) cited combined oral contraceptives, 73.2% cited intrauterine devices, and 9.8% cited other methods (mifepristone, high-dose estrogen, menstrual regulation). Seventy-eight per cent of the family-planning providers stated that they had applied emergency contraception previously, while 53.7% gave limited support to emergency contraception. Two sample cases were given to family-planning providers to define their attitudes, to the first of which most of them were positive. All of them were positive towards the second sample. CONCLUSION: Family-planning providers, whose duty is to support women in critical family-planning and reproductive decisions using their experiences and skills, are supposed to have broad knowledge on the matter of emergency contraception.

Adult↗