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Wali R, Alghamdi AM, Ahmed ST, Gammash AM, Bukhari MM, Alkhozam KF, Asiri MH. Satisfaction With the Use of Subdermal Contraceptive Implant in Women Attending the Specialized Polyclinic Primary Health Care Center in Jeddah City: A Cross-Sectional Study. Cureus 2023; 15:e35902. [PMID: 37033501 PMCID: PMC10081069 DOI: 10.7759/cureus.35902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Subdermal contraceptive implants are a convenient method of contraception for many women due to the ease of insertion and removal and because they require less follow-up with their health facility. In addition to the contraceptive benefits, women's satisfaction with such devices is essential, as this can affect their quality of life. This study aims to measure women's satisfaction with the subdermal contraceptive implant, Implanon® (Organon & Co., Jersey City, New Jersey, United States), its main side effects, and reasons for removal. Methods A cross-sectional study was conducted on women between the ages of 19 and 65 years who visited the Family Planning Clinic at the Specialized Polyclinic Primary Health Care Center in Jeddah, Saudi Arabia, between January 2018 and December 2021. An online questionnaire was distributed to the women who had Implanon inserted and 84 responded. Demographic and contraceptive data were collected, including the dates of insertion and removal of Implanon and side effects experienced while on Implanon. Results Of the 84 women, 65.84% were satisfied with Implanon, while only 19.04% were unsatisfied with the implant. The most common side effect reported was weight gain (54.76%), followed by menstrual Irregularity. (39.29%). The most common reason for removal was the end of the implant's contraceptive duration (42.86%). Conclusion Most of the women treated at this primary healthcare clinic were satisfied with Implanon. In addition, most of the women removed the implant only due to its reaching the end of its contraceptive duration despite experiencing side effects, and most women said that they would recommend it to their family and friends.
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Affiliation(s)
- Razaz Wali
- Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulkarim M Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Samer T Ahmed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulaziz M Gammash
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed M Bukhari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Khozam F Alkhozam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mouath H Asiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
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Hassan Ilegbusi P. Contraceptive Implants. Stud Fam Plann 2022. [DOI: 10.5772/intechopen.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contraceptive implants or implantable contraceptive are five subdermal implants, rods the size of pencil lead that are embedded just under the skin on the inside of the upper arm. The rods contain etonogestrel, the metabolite of desogestrel, an equivalent progestin. Implants are often used during breastfeeding without an impact on milk production. It was identified that age does not affect the use of contraceptive implants but educational status is significant to its usage; there is an association between the age at first birth and the use of contraceptive implants; the number of liveborn children has a significant impact or influence on the use of implants; etc. This chapter focuses on types of contraceptive implants and its mechanism of action; global statistics on contraceptive implants; side effects; health benefits and positive characteristics of contraceptive implants; those who can and cannot use contraceptive implants; reasons women are not interested in contraceptive implants and factors influencing its usage.
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Synthetic Progestins in Waste and Surface Waters: Concentrations, Impacts and Ecological Risk. TOXICS 2022; 10:toxics10040163. [PMID: 35448424 PMCID: PMC9026682 DOI: 10.3390/toxics10040163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023]
Abstract
Synthetic progestins (PGs) are a large family of hormones used in continuously growing amounts in human and animal contraception and medicinal therapies. Because wastewater treatment plants (WWTPs) are unable to eradicate PGs after excretion, they are discharged into aquatic systems, where they can also be regenerated from conjugated PG metabolites. This review summarises the concentrations of 12 PGs in waters from 2015 to 2021. The selected PGs were considered of particular interest due to their wide use, activity, and hormonal derivation (from testosterone, progesterone, and spirolactone). We concluded that PGs had been analysed in WWTPs influents and effluents and, to a lesser extent, in other matrices, including surface waters, where their concentrations range from ng/L to a few µg/L. Because of their high affinity for cell hormone receptors, PGs are endocrine disruptor compounds that may alter the reproductive fitness and development of biota. This review focused on their biological effects in fish, which are the most used aquatic model organisms to qualify the impacts of PGs, highlighting the risks that environmental concentrations pose to their health, fecundity, and fertility. It is concluded that PGs research should be expanded because of the still limited data on their environmental concentrations and effects.
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Ambacher K, Secter M, Sanders AP. The use of progestin subdermal implants in the management of endometriosis-related pain symptoms and quality of life: a systematic review. Curr Med Res Opin 2022; 38:479-486. [PMID: 35048754 DOI: 10.1080/03007995.2022.2031144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to evaluate the evidence for the use of progestin subdermal implants for the treatment of endometriosis-related pain symptoms and quality of life. METHODS A literature search of PubMed, Ovid (MEDLINE and EMBASE), and Web of Science was performed from inception to December 2020. In addition, a targeted search of cited references was also performed. Our search identified 330 articles of which 17 were deemed eligible for full-text review. Eligible studies included randomized control trials, observational studies, and case series with at least 5 cases, investigating the effect of progestin subdermal implants on endometriosis-related pain scores in women of reproductive age with a clinical, radiologic, or surgical diagnosis of endometriosis. Six articles were excluded after the full-text screen. RESULTS Eleven articles describing a total of 335 patients were eligible for inclusion. Across all studies, etonogestrel- and segesterone-releasing progestin subdermal implants improved VAS pain scores for cyclic pelvic pain/dysmenorrhea (VAS at baseline ranged from 6.1 to 7.5 cm and after treatment from 1.7 to 4.9 cm, n = 121), non-cyclic pelvic pain (baseline VAS 7.2-7.6 cm and after treatment 2.0-3.7 cm, n = 96) and dyspareunia (baseline VAS 1.61-8.3 cm and after treatment 1.0-7.1 cm, n = 87). Symptom improvement with the progestin subdermal implant was equivalent to treatment with depot medroxyprogesterone acetate (DMPA; average baseline VAS 6.5 and after DMPA treatment 3.0, compared to 2.0 after treatment with the implant) or the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS; baseline cyclic and non-cyclic pain scores 7.3 and 7.4 respectively decreased to 1.9 and 1.9 after LNG-IUS treatment). Improvements were also demonstrated in quality-of-life scores (average improvement of 36% in all domains of the Endometriosis Health Profile-30 and significant improvements in social functioning, general health, bodily pain, vitality and mental health domains on the Short Form-36 questionnaire) and sexual function (total sexual function score improved from 24 to 25.35 and 26.25 at 6 and 12 months). CONCLUSION Etonogestrel- and segesterone-releasing progestin subdermal implants appear to improve endometriosis-related pain symptoms and quality of life and may provide an additional component in the management of endometriosis. However, this systematic review is limited by the small sample size and heterogeneity in the data. As such, larger prospective randomized trials are needed to guide further management. PROSPERO REGISTRATION CRD42021225665.
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Affiliation(s)
- Kristin Ambacher
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, AB, Canada
| | - Michael Secter
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, AB, Canada
| | - Ari P Sanders
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, AB, Canada
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Rafiei F, Tabesh H, Farzad S, Farzaneh F, Rezaei M, Hosseinzade F, Mottaghy K. Development of Hormonal Intravaginal Rings: Technology and Challenges. Geburtshilfe Frauenheilkd 2021; 81:789-806. [PMID: 34276064 PMCID: PMC8277443 DOI: 10.1055/a-1369-9395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
Intravaginal rings (IVRs) are minimally invasive polymeric devices specifically designed to be used for the sustained and prolonged release of various type of drugs such as hormones. One of the benefits of using topical drug delivery systems (e.g., IVRs) is the fact that systemic drug delivery may cause drug resistance due to elevated drug levels. Topical drug delivery also provides higher concentrations of the drug to the target site and has fewer side effects. In addition, when a drug is administered vaginally, the hepatic first-pass effect is avoided, resulting in higher absorption. Contraception and treatments for specific diseases such as endometriosis and hormone deficiencies can be improved by the administration of hormones via an IVR. This article aims to classify and compare various designs of commercially available and non-commercial hormonal IVRs and to analyze their performance. Current challenges affecting the development of IVRs are investigated, and
proposed solutions are discussed. A comprehensive search of publications in MEDLINE/PubMed and of commercial product data of IVRs was performed, and the materials, designs, performance, and applications (e.g., contraception, endometriosis, estrogen deficiency and urogenital atrophy) of hormonal IVRs were thoroughly evaluated. Most hormonal IVRs administer female sex hormones, i.e., estrogen and progestogens. In terms of material, IVRs are divided into 3 main groups: silicone, polyurethane, and polyethylene-co-vinyl acetate IVRs. As regards their design, there are 4 major designs for IVRs which strongly affect their performance and the timing and rate of hormone release. Important challenges include reducing the burst release and maintaining the bioavailability of hormones at their site of action over a prolonged period of administration as well as lowering production costs. Hormonal IVRs are a promising method which could be used to facilitate combination therapies by
administering multiple drugs in a single IVR while eliminating the side effects of conventional drug administration methods. IVRs could considerably improve womenʼs quality of life all over the world within a short period of time.
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Affiliation(s)
- Fojan Rafiei
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Hadi Tabesh
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Shayan Farzad
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States
| | - Farah Farzaneh
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rezaei
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Fateme Hosseinzade
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Khosrow Mottaghy
- Institute of Physiology, RWTH Aachen University, Aachen, Germany
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Rocca ML, Palumbo AR, Visconti F, Di Carlo C. Safety and Benefits of Contraceptives Implants: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:548. [PMID: 34201123 PMCID: PMC8229462 DOI: 10.3390/ph14060548] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.
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Affiliation(s)
- Morena Luigia Rocca
- Operative Unit of Obstetric and Gynaecology, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Anna Rita Palumbo
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
| | - Federica Visconti
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
| | - Costantino Di Carlo
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
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Rivera F, Bianciotto A. Contraceptive subcutaneous device migration: what does an orthopaedic surgeon need to know? A case report and literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:232-237. [PMID: 32555102 PMCID: PMC7944845 DOI: 10.23750/abm.v91i4-s.9498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/10/2020] [Indexed: 11/23/2022]
Abstract
Subdermal contraceptive implant is approved in more than 60 countries and used by millions of women around the world. Although relatively safe in nature, their implantation and removal may be associated with potential complications, some of which may require surgical intervention. Two types of peripheral neurological complications are reported: complications related to compressive neuropathy caused by device decubitus and complications related to device improper removal. An healthy 35-year-old woman come to our attention for paresthesia from medial side of right elbow to fourth and fifth fingers. Tinel sign was positive on medial side of distal third of right arm, above the elbow, as well. Clinical history of patients revealed a subcutaneous placement of a etonogestrel implant 3 years before. Patients reported disappearing of tactile feeling of subcutaneous contraceptive implant since two months. At clinical examination, implant was not felt in its original subcutaneous place. X-rays control revealed its proximal and deep migration. Surgical exploration for subcutaneous contraceptive implant removal revealed it lying on the ulnar nerve. Patient referred immediate paresthesia disappearing after surgery. At 1 month follow up no motor or sensory alteration were evident. Removal of implants inserted too deeply must be carefully performed to prevent damages to nervous and vascular structures and it should be performed by operators who are very familiar with the anatomy of the arm. In case of chronic neuropathy caused by implant nerve compression only an appropriate patients information about rare but possible neuropathic symptoms related to device migration and a careful medical history collecting can avoid a mistaken diagnosis of canalicular syndrome.
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Affiliation(s)
- Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, Savigliano (CN), Italy.
| | - Andrea Bianciotto
- Department of Obstetrics and Gynaecology, SS Annunziata Hospital, Savigliano, CN, Italy.
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9
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Mullins ES, Miller RJ, Mullins TLK. Abnormal Uterine Bleeding in Adolescent Women. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thew M. Etonogestrel Implant-To Leave or Stay: A Case Series. Glob Pediatr Health 2017; 4:2333794X17738844. [PMID: 29204458 PMCID: PMC5700782 DOI: 10.1177/2333794x17738844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
Long-acting reversible contraception, which include etonogestrel subdermal hormonal implants, has high efficiency rates in preventing teen pregnancy. Although these numbers are increasing, teens have the lowest long-acting reversible contraception usage rate of any group, which the American Congress of Obstetricians and Gynecologists addressed with recommendations for Nexplanon placement for teens. The American Congress of Obstetricians and Gynecologists has recommended support for increased use and training of practitioners and pediatricians to gain momentum. Safety remains a concern as increased usage by practitioners and pediatricians may lead to more adverse outcomes. Despite the improvements to Nexplanon as a preloaded insertion device to prevent deep placement and malalignment, there are few known published adverse outcomes. Although different products, a review of the adverse outcomes reported with Norplant removal may closely reflect today's concerns with Nexplanon. The 3 case studies in this article are examples of similar adverse outcome with Nexplanon removal as those reported with Norplant.
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Zigler RE, McNicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol 2017; 216:443-450. [PMID: 27988268 DOI: 10.1016/j.ajog.2016.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/29/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
Nearly 20% of women using contraception are using progestin-only contraception, including progestin-only pills, depot-medroxyprogesterone acetate, subdermal etonogestrel implants, and levonorgestrel intrauterine devices. This number will continue to grow with the increased provision of long-acting reversible contraception. Although overall satisfaction among women using progestin-only contraception is high, dissatisfaction and discontinuation may be associated with unscheduled bleeding and spotting. The exact etiology of irregular bleeding associated with progestin-containing contraceptives is not completely understood, yet several mechanisms have been suggested. Several therapies targeting these mechanisms have been evaluated with mixed results. This paper will review the physiology and management of unscheduled bleeding with progestin-containing contraceptives.
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Family Planning and Contraception. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Villas-Boas J, Vilodre LC, Malerba H, Pontremoli Salcedo M, Foresti Jiménez M, El Beitune P. Metabolic safety of the etonogestrel contraceptive implant in healthy women over a 3-year period. Eur J Obstet Gynecol Reprod Biol 2016; 202:51-4. [PMID: 27164485 DOI: 10.1016/j.ejogrb.2016.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/17/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To ascertain whether placement of the etonogestrel contraceptive implant induces significant changes in carbohydrate and lipid metabolism, as reflected by metabolic parameters, in healthy women. STUDY DESIGN Prospective cohort study of 213 healthy patients who received etonogestrel implants. Weight, BMI, blood pressure and a comprehensive metabolic profile were assessed at baseline, 1, 2 and 3 years. In 21 of the 213 participants, AUC for glucose levels, fasting insulin levels at baseline and year 3 (immediately before implant removal), HOMA-IR score, and the QUICK index were assessed. Parameters were expressed as median and interquartile range. The Wilcoxon test and ANOVA were used for comparison of measurements after implant placement (significance level p<0.05). RESULTS Median age was 26 years (range, 22-31.5). Results showed a trend toward increase of the variables weight (63.3-66.1) and BMI (24.7-25.7) and a decrease in TC (172-161.5), TG (75-69.5), and LDL (100.5-98.5) (p>0.05). Of the metabolic variables, FBG (85-88) and HDL (53-46) had significant differences (p<0.002). In the subgroup of 21 patients, there were reductions in insulin levels (9.65 vs. 8.4mU/dL, p=0.03), HOMA scores (2.06 vs. 1.75, p=0.02), QUICK index (0.34 vs. 0.35, p=0.03), TC (178 vs. 160mg/dL, p=0.001), HDL (51 vs. 46mg/dL, p=0.009), and LDL (110 vs. 100mg/dL, p=0.035). CONCLUSION These results provide evidence of the metabolic safety of the ENG implant in healthy women over a 3-year period. Indeed, implant placement induces changes consistent with a lower risk of insulin resistance and dyslipidemia.
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Affiliation(s)
- Jaqueline Villas-Boas
- Specialized in Obstetrics and Gynecology, Hysteroscopy, Sexually Transmitted Diseases and Sexual Violence, Porto Alegre, Brazil; Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil
| | - Luiz C Vilodre
- Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil; Obstetrics and Gynecology, Universidade Luterana do Brasil (ULBRA), Porto Alegre, Brazil
| | - Helena Malerba
- Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil; Public Health Nurse, Porto Alegre, Brazil
| | - Mila Pontremoli Salcedo
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Mirela Foresti Jiménez
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Patrícia El Beitune
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil.
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Rocca ML, Venturella R, Mocciaro R, Di Cello A, Sacchinelli A, Russo V, Trapasso S, Zullo F, Morelli M. Polycystic ovary syndrome: chemical pharmacotherapy. Expert Opin Pharmacother 2015; 16:1369-93. [PMID: 26001184 DOI: 10.1517/14656566.2015.1047344] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disease among women of childbearing age. The clinical features are heterogeneous and vary in intensity. Hirsutism, menstrual disorders and infertility are the most frequent conditions observed; however, long-term complications (dyslipidemia, hypertension, cardiovascular disease, type 2 diabetes mellitus, endometrial cancer) are also often described. Each disorder may be managed by tailored strategies, employing sequential or combined pharmacological and/or non-pharmacological treatment. AREAS COVERED The authors review the drugs used for PCOS management and discuss new approaches. A systematic MEDLINE search regarding the randomized controlled trials, retrospective and observational studies about medical treatments of PCOS, the Cochrane library for reviews and also search for registered trials on ClinicalTrials.gov is performed. EXPERT OPINION A uniform treatment for PCOS patients does not exist. Clinicians should perform an accurate evaluation of patients' characteristics, identifying the phenotypic target and, subsequently, the best-tailored treatment to manage one or more clinical issues. Lifestyle intervention should always be the first recommended approach unless other issues indicate that drug or hormonal interventions are superior.
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Affiliation(s)
- Morena Luigia Rocca
- 'Magna Graecia' University, Cancer Center of Excellence "Tommaso Campanella" of Germaneto, Department of Experimental and Clinical Medicine, Unit of Obstetrics and Gynaecology, Oncology Unit , Viale Europa, loc. Germaneto, 88100, Catanzaro , Italy +39 328 5692428 ; +39 0961 883234 ;
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Body composition and bone mineral density in users of the etonogestrel-releasing contraceptive implant. Arch Gynecol Obstet 2015; 292:1387-91. [DOI: 10.1007/s00404-015-3784-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Contraception 2014; 90:253-8. [PMID: 24973904 DOI: 10.1016/j.contraception.2014.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/08/2014] [Accepted: 05/21/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether the discontinuation rate of the etonogestrel contraceptive implant due to irregular vaginal bleeding among women with immediate postpartum insertion is increased compared to delayed postpartum and interval placement. STUDY DESIGN This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) to delayed postpartum (6 to 12 weeks postpartum) and interval insertion between January 2008 and December 2010. Charts were reviewed for date and reason for removal. A chi-squared test was used to compare discontinuation due to bleeding between cohorts. Baseline characteristics predictive of implant removal were evaluated by simple logistic regression. RESULTS There were 259 women in the immediate postpartum group, 49 in the delayed postpartum group and 106 in the interval group. Average age at insertion was 22.6 (±5.5) years. Overall, 19.3% of women in the immediate postpartum group requested removal due to irregular bleeding compared to 18.4% in the delayed postpartum group [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.48-2.33] and 20.8% in the interval group (OR 0.91, 95% CI 0.52-1.60). There was no difference between groups in premature removal rates for any side effect. There were no sociodemographic or clinical characteristics predictive of removal in any group. CONCLUSION One-fifth of etonogestrel contraceptive implant users requested premature removal due to irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates and may help reduce unintended pregnancy. Mechanisms to help women manage irregular bleeding due to the implant are needed. IMPLICATIONS Immediate postpartum insertion of the etonogestrel contraceptive implant does not lead to increased removal rates due to vaginal bleeding compared to delayed postpartum or interval insertion. Immediate postpartum implant insertion may increase uptake of long-acting reversible contraception and help reduce short interpregnancy intervals and unintended pregnancy.
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EVAPIL-R Scale: Continuous Development and Validation of a Tool to Assess Patient-Reported Tolerability of Different Contraceptive Methods in Longitudinal Studies. Clin Ther 2014; 36:638-647.e3. [DOI: 10.1016/j.clinthera.2014.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/17/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022]
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Global Introduction of a Low-Cost Contraceptive Implant. CRITICAL ISSUES IN REPRODUCTIVE HEALTH 2014. [DOI: 10.1007/978-94-007-6722-5_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Greenberg GM, Ursu A, Hertz MI. Family Planning and Contraception. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Subdermale kontrazeptive Implantate. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-012-0536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Simmons KB, Edelman AB, Li H, Yanit KE, Jensen JT. Personalized contraceptive assistance and uptake of long-acting, reversible contraceptives by postpartum women: a randomized, controlled trial. Contraception 2013; 88:45-51. [DOI: 10.1016/j.contraception.2012.10.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
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An update on contraceptive therapy options. Am J Ther 2013; 16:44-55. [PMID: 22573055 DOI: 10.1097/mjt.0b013e31816b9012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The introduction of new contraception formulations and different routes of administration offers women more options when choosing birth control methods. Despite new options, there are still risks to consider when prescribing contraception to women on an individual basis. In the past 5 years alone, there has been the introduction of extended and continuous cycle oral contraceptives, a new subdermal implant, and shorter hormone-free intervals in 28-day cycles. Cardiovascular risks including stroke, myocardial infarction, and venous thromboembolism are risks that must still be considered in certain populations. In 2005, the Food Drug and Administration issued a press release concerning the higher exposure to estrogen in the transdermal patch compared with 35-μg oral contraceptives. This statement led to concerns of serious adverse events. Women who have no contraindications for contraception continue to struggle with adherence to daily, weekly, and even monthly regimens. Patients must take responsibility for taking their contraception as scheduled or risk becoming pregnant. The relationship of weight and efficacy of combined hormonal contraception is a concern that many health care practitioners have, and unfortunately, the data available do not answer the question at this time. The most important aspect of prescribing contraception is communication with the patient. Taking complete histories and prescribing contraceptive methods on an individualized basis will offer the patient the optimal method available to the patient.
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Impact of etonogestrel-releasing implant and copper intrauterine device on carbohydrate metabolism: a comparative study. Contraception 2012; 85:173-6. [DOI: 10.1016/j.contraception.2011.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/19/2022]
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Guazzelli CA, de Queiroz FT, Barbieri M, Barreiros FA, Torloni MR, Araujo FF. Metabolic effects of contraceptive implants in adolescents. Contraception 2011; 84:409-12. [DOI: 10.1016/j.contraception.2011.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
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Wiegratz I, Thaler CJ. Hormonal contraception--what kind, when, and for whom? DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:495-505; quiz 506. [PMID: 21814535 PMCID: PMC3149298 DOI: 10.3238/arztebl.2011.0495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 06/20/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Germany today, one-third of the 20 million women of child-bearing age use combined oral contraceptives (COCs). In this article, we summarize the current knowledge of the mode of action, wanted and unwanted side effects, and long-term risks of COCs. The levonorgestrel intrauterine device (IUD) and long-acting injectable or implantable monophasic progestogen preparations offer comparable contraceptive efficacy to COCs. Nonetheless, they are less frequently used in Germany than COCs, because of their propensity to cause breakthrough bleeding. METHOD Selective review of the literature. RESULTS COCs suppress gonadotropin secretion and thereby inhibit follicular maturation and ovulation. Their correct use is associated with 0.3 pregnancies per 100 women per year, their typical use, with 1 pregnancy per 100 women per year (Pearl index). COCs have effects on the cardiovascular and hemostatic systems as well as on lipid and carbohydrate metabolism. When given in the presence of specific risk factors, they significantly increase the likelihood of cardiovascular disease and thromboembolism. Women with persistent human papilloma virus (HPV) infection who take COCs are at increased risk of developing invasive cervical cancer. On the other hand, COCs lower the cumulative incidence of endometrial and ovarian cancer by 30% to 50%, and that of colorectal cancer by 20% to 30%. Other malignancies seem to be unaffected by COC use. CONCLUSION As long as personal and familial risk factors are carefully considered, COCs constitute a safe, reversible, and well-tolerated method of contraception.
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MESH Headings
- Cardiovascular Diseases/chemically induced
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Drug Implants
- Drug-Related Side Effects and Adverse Reactions
- Female
- Germany
- Humans
- Injections, Intramuscular
- Intrauterine Devices, Medicated
- Levonorgestrel
- Papillomavirus Infections/complications
- Pregnancy
- Pregnancy, Unwanted
- Progesterone Congeners/administration & dosage
- Progesterone Congeners/adverse effects
- Risk Factors
- Thromboembolism/chemically induced
- Uterine Cervical Neoplasms/chemically induced
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Affiliation(s)
- Inka Wiegratz
- Klinik für Frauenheilkunde und Geburtshilfe, Schwerpunkt Gynäkologische Endokrinologie und Reproduktionsmedizin, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Germany.
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Guazzelli CA, de Queiroz FT, Barbieri M, Torloni MR, de Araujo FF. Etonogestrel implant in adolescents: evaluation of clinical aspects. Contraception 2011; 83:336-9. [DOI: 10.1016/j.contraception.2010.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 08/05/2010] [Accepted: 08/06/2010] [Indexed: 11/28/2022]
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Guazzelli CAF, de Queiroz FT, Barbieri M, Torloni MR, de Araujo FF. Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate. Contraception 2010; 82:256-9. [DOI: 10.1016/j.contraception.2010.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 02/03/2010] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
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Jørgensen NP. [Contraceptive implants--aberrations from insertion and removal procedures]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:733-4. [PMID: 20379334 DOI: 10.4045/tidsskr.08.0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Contraceptive implants with progestogens are options for women who need long-term contraception. Implanon which contains etonogestrel (the active metabolite of desogestrel) effectively prohibits ovulation over a period of three years. This study presents aberrations from insertion and removal procedures for Implanon in the period 2 February 2002 - 30 June 2008. MATERIAL AND METHODS Information about sales of Implanon in Norway is taken from statistics provided by Farmastat Norway. Aberrations from procedures for insertion and removal of Implanon are based on reports from doctors to the producer. Non-palpable implants to be removed at Volvat Medical Centre in Oslo, were localized by ultrasound and removed surgically. RESULTS In the period 2 February 2002 - 30 June 2008, the producer Organon AS (now Schering- Plough AS) sold 12 898 Implanon implants in Norway and recorded 112 aberrations from existing procedures, the first one 3 March 2003. 18 patients were referred for removal of implants (too deeply inserted) at Volvat Medical Centre in the period 19 January 2004 - 30 June 2008. INTERPRETATION The number of unsuccessful or wrongly inserted implants indicates that doctors should have practiced and be better informed about insertion and removal procedures before using this method. Localization and removal of implants inserted too deeply requires high-frequency ultrasound equipment and surgical experience.
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Affiliation(s)
- C Stanley Chan
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
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Murat Inal M, Yildirim Y, Ertopcu K, Eftal Avci M, Ozelmas I, Tinar S. Effect of the subdermal contraceptive etonogestrel implant (Implanon®) on biochemical and hormonal parameters (three years follow-up). EUR J CONTRACEP REPR 2009; 13:238-42. [DOI: 10.1080/13625180802075315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vicente L, Mendonça D, Dingle M, Duarte R, Manuel Boavida J. Etonogestrel implant in women with diabetes mellitus. EUR J CONTRACEP REPR 2009; 13:387-95. [DOI: 10.1080/13625180802382604] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spencer AL, Bonnema R, McNamara MC. Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications. Am J Med 2009; 122:497-506. [PMID: 19486709 DOI: 10.1016/j.amjmed.2009.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 12/26/2008] [Accepted: 01/06/2009] [Indexed: 10/20/2022]
Abstract
Primary care physicians frequently provide contraceptive counseling to women who are interested in family planning, have medical conditions that may be worsened by pregnancy, or have medical conditions that necessitate the use of potentially teratogenic medications. Effective counseling requires up-to-date knowledge about hormonal contraceptive methods that differ in hormone dosage, cycle length, and hormone-free intervals and are delivered by oral, transdermal, transvaginal, injectable, or implantable routes. Effective counseling also requires an understanding of a woman's preferences and medical history as well as the risks, benefits, side effects, and contraindications of each contraceptive method. This article is designed to update physicians on this information.
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Affiliation(s)
- Abby L Spencer
- Department of Medicine, Section of General Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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Abstract
The human costs of unintended pregnancy-abortion and parenting under difficult circumstances-are high. For this reason, all physicians who treat female patients should be knowledgeable about the basics of contraception-both its practical uses and its public health impact. This knowledge will make physicians, including internists, better able to counsel and provide contraceptives for individual patients and to advocate for availability and access. This article discusses the problem and determinants of unintended pregnancy and reviews contraceptive methods.
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Affiliation(s)
- Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC 08 4700, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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