New methods of pregnancy testing in adolescent girls

Contraceptive efficacy of norethindrone encapsulated in injectable biodegradable poly-dl-lactide-co-glycolide microspheres: phase II clinical study

Contraceptive efficacy of injectable norethindrone (NET) microspheres of 90 day duration was evaluated for 6 months: nine women received two injections of 65 mg each and eight received two injections of 100 mg each with 90 days between each injection. Average serum NET levels were 5 to 9 ng/mL on the day after injection and subsequently remained at 1 to 3 ng/mL. With 65 and 100 mg doses, respectively, 36% and 25% of cycles had normal bleeding patterns, 36% and 48% were amenorrheic, and the remaining 28% and 27% had prolonged bleeding. Also, 56% and 40% of cycles showed increased spotting for the 65 mg and 100 mg dose, respectively. There was no incidence of pregnancy or serious side effects. The mean serum NET concentration returned to RIA nonspecific basal levels 100 days after the second injection. Women returned to ovulatory cycles between days 100 to 115 after the second injection.

Pregnancy testing and counseling

Pregnancy testing and counseling are increasingly accepted as necessary services for adolescents within the primary care setting. For teenagers in need of a pregnancy test, the easy-to-perform, highly sensitive and specific enzyme immunoassay analysis for measuring beta-human chorionic gonadotropin (beta-HCG) is ideal. However, no single beta-HCG analysis should be taken as absolute evidence for the presence or absence of pregnancy. Instead, an integrated approach using all of the health care professional's skills in adolescent health care should be taken. In some cases a careful history and physical examination will confirm the pregnancy. At other times serial quantitative serum HCG titers, pelvic ultrasonography, and culdocentesis may be necessary to rule out the possibility of ectopic pregnancy or threatened abortion. For more than three quarters of pregnant adolescents the pregnancy is unplanned and may represent a major conflict for themselves, their partner, and their families. When such an event occurs the health care professional will frequently be sought as a resource. Successful pregnancy counseling has many components. The adolescent will need to visualize the counselor as an available, sensitive, nonjudgmental individual who believes in the right of the pregnant teenager ultimately to progress to her own decision. The counseling process should be firmly based on an understanding of adolescent psychosocial and biologic development, crises intervention techniques, and family dynamics. The counselor needs to be a reliable information source. If the adolescent decides to go to term, programs offering comprehensive prenatal services to teenagers should be identified. Information concerning high-quality, low-cost abortion services also will need to be available for those who wish to terminate. It is important to monitor the quality of care given in prenatal and abortion service referrals. Few adolescents currently choose to place their babies for adoption. Counseling in this area is especially needed. Several types of adoption procedures are available and at appropriate times during a teenager's neonatal care adoption should be presented as a reasonable alternative to parenthood. Throughout this process, the health care professional will have opportunities to discuss a wide variety of health related topics with the adolescent and often her partner and their respective families. Ideally, whatever her final decision, it is the goal of the counselor to make the experience a positive and maturing influence on her life and the lives of other persons involved.

Abnormal vaginal bleeding in adolescents

The evaluation and management of abnormal vaginal bleeding should be tailored to the individual case. Pediatricians caring for adolescents need to be skilled in the evaluation and management of this common adolescent problem. Physicians who do not feel comfortable with their skills in the performance of a pelvic exam should obtain consultation from an adolescent specialist or a gynecologist who has experience with adolescents.

What's new in pregnancy tests

Immunologically based pregnancy tests that will diagnose pregnancy even before the menstrual period is missed are now available. Nurses who deal with female patients in the reproductive years must be aware of these newer pregnancy tests now in use. Appropriate interpretation of pregnancy tests will aid women in early pregnancy to avoid potentially harmful radiation, drugs, or treatments.

Contraceptive efficacy of bioabsorbable pellets of norethindrone (NET) as subcutaneous implants: phase II clinical study

The contraceptive efficacy of norethindrone (NET) fused pellets was evaluated over 12 months in a Phase II clinical study with three and four pellets, each pellet containing 35 mg of NET. Volunteers were healthy, fertile, sexually active women. The release rate of NET from three and four pellets, respectively, was 150.3 +/- 7.2 micrograms and 212.5 +/- 8.6 micrograms NET/day. Following the implantation of NET pellets, serum NET levels did not show any 'burst effect' and were sustained at levels between 0.4 and 0.6 ng NET/ml serum with three pellets and 0.6-0.7 ng NET/ml serum with four pellets. With three and four pellets, respectively, 40% and 27% of the women had normal menstrual cycles; 20% and 14% were amenorrheic; 27% and 37% had mid-menstrual spotting or bleeding; and 13% and 22% had prolonged episodes of bleeding. Cardiovascular, hepatic, and renal functions were normal throughout the study. Ovulation was inhibited in 85% and 92% of the cycles with three and four pellets, respectively. In women using three pellets, two pregnancies occurred, one at the 6th cycle and another at the 12th cycle. In women using four pellets, no pregnancies occurred during the entire period of study.

Diagnosis of adolescent pregnancy--1965 vs 1980

The study compares changes in the accuracy of the diagnosis of pregnancy in adolescents between 1965 and 1980. We compared 44 records of adolescents evaluated in 1965 to those of 44 who were evaluated 15 years later in 1980. The following data were examined: (1) reason for consultation, (2) amount of time prior to making the correct diagnosis, and (3) the most common diagnostic errors. The results showed that (1) the initial diagnosis was correct only 75 per cent of the time in 1965 and 86 per cent in 1980, (2) both in 1965 and 1980 most patients initially consulted for "vague complaints," (3) in 1965 and 1980 the most common diagnostic errors were "gastrointestinal disorder" and "functional symptoms," and (4) pregnancy was diagnosed earlier in 1980 than in 1965. Improvement in diagnostic accuracy should be possible if clinicians screen for pregnancy in adolescent girls consulting for vague symptoms such as nausea, weight gain, urticaria, and somnolence.

Menstruation and its disorders in adolescence

This monograph has presented a review of menstrual disorders in adolescents. It has been emphasized that health care professionals who deal with youths should consider a comprehensive approach that places the youth with a menstrual problem within the framework of her adolescent and pubertal development. Thus, a discussion of psychologic growth as well as important aspects of puberty were presented. A thorough medical history and carefully done pelvic examination remain the basis for any evaluation of these young women even in this age of rapidly-advancing medical technology. Many of the menstrual dysfunction problems are related to the sequential, physiologic events of puberty and can be effectively handled by the well-trained general clinician. Specific, complex situations should be referred to the appropriate specialist, preferably someone with an understanding of adolescence. Three basic types of menstrual disorders have been considered: dysmenorrhea, dysfunctional uterine bleeding and amenorrhea. Our conclusion is that there is much the general clinician can do for the adolescent who presents with menstrual dysfunction.