RESUMO
The experience of 6 million Norplant users has led to several more advanced implants. Implanon is a single-rod implant system containing a low androgenic progestin and requires 1 to 2 minutes for insertion and removal. Like other implants, Implanon prevents pregnancy by changing the character of the cervical mucus and interfering with luteal function. Unlike Norplant, though, Implanon is designed to prevent ovulation for the full duration of use. Implant contraception has several advantages over other types of contraception including high efficacy, minimal required maintenance, absence of estrogen, and rapid return of fertility after discontinuation. Implants can be a good choice for adolescents; women with hypertension, diabetes, anemia, endometriosis, or other medical problems; and women who are breast-feeding. Irregular bleeding is the most common adverse effect of implants and can be treated with several medication regimens. Preinsertion counseling, however, is the most important factor in ensuring satisfaction with implants. Unfortunately, no implant system is currently available in the United States since August 2000, but Implanon is expected to reach the U.S. market within the next 2 years.
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Desogestrel , Implantes de Medicamento/administração & dosagem , Megestrol/análogos & derivados , Congêneres da Progesterona/administração & dosagem , Muco do Colo Uterino/efeitos dos fármacos , Ensaios Clínicos como Assunto , Anticoncepcionais Femininos/economia , Anticoncepcionais Femininos/farmacologia , Aconselhamento , Endométrio/efeitos dos fármacos , Feminino , Humanos , Levanogestrel/administração & dosagem , Levanogestrel/farmacologia , Megestrol/administração & dosagem , Megestrol/farmacologia , Norprogesteronas/administração & dosagem , Norprogesteronas/farmacologia , Ovulação/efeitos dos fármacos , Satisfação do Paciente , Gravidez , Congêneres da Progesterona/economia , Congêneres da Progesterona/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Compostos de Vinila/administração & dosagem , Compostos de Vinila/farmacologiaAssuntos
Abortivos não Esteroides , Aborto Induzido/métodos , Gonadotropina Coriônica Humana Subunidade beta/sangue , Endométrio/anatomia & histologia , Antagonistas de Estrogênios , Misoprostol , Tamoxifeno , Endométrio/diagnóstico por imagem , Endométrio/efeitos dos fármacos , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos , UltrassonografiaRESUMO
The objectives of this prospective non-concurrent cohort study were to confirm the efficacy of vaginal misoprostol for early pregnancy termination and to determine whether the incidence of side effects is lower with prophylactic loperamide and acetaminophen. Two-hundred women with an intrauterine pregnancy < or =56 days gestational age seeking medical pregnancy termination in an ambulatory research clinic were enrolled in the study. One-hundred participants (group 1) ingested 4 mg of loperamide and 500 mg of acetaminophen before the vaginal placement of 800 mirog of misoprostol moistened with 2 mL of saline. If abortion had not occurred, the same regimen was repeated every 24 h (maximum three doses). One-hundred participants (group 2) from the same clinic who previously underwent the same misoprostol regimen without prophylactic medication served as a control group for comparison with respect to abortion success and the incidence of side effects. The rate of successful abortion was not statistically significantly different between the two groups (group 1 93%, group 2 89%). The incidence of opiate analgesic use was significantly less in group 1 (4%) compared with group 2 (16%) (OR 0.22, 95% CI 0.06-0.73, p = 0.01). There was a significantly lower incidence of diarrhea in group 1 (23%) compared with group 2 (44%) (OR 0.38, 95% CI 0.20-0.73, p = 0.003). There was no difference in the incidence of fever/chills or the incidence of emesis between the two groups. Vaginal misoprostol is effective for termination of pregnancy < or = 56 days and the incidence of diarrhea and the use of opiate analgesia is significantly reduced with prophylactic loperamide and acetaminophen.
Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido , Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Antidiarreicos/administração & dosagem , Loperamida/administração & dosagem , Misoprostol/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Estudos de Coortes , Diarreia/induzido quimicamente , Diarreia/epidemiologia , Diarreia/prevenção & controle , Feminino , Febre/epidemiologia , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Misoprostol/efeitos adversos , Satisfação do Paciente , Gravidez , Inquéritos e Questionários , Vômito/epidemiologiaRESUMO
Although levonorgestrel contraceptive implants have been available for over 15 years, innovations have only recently led to a wider choice. These new implants offer easier insertion and removal and other advantages depending on the type of progestin. Implants prevent pregnancy by several mechanisms, including inhibition of ovulation and luteal function and alteration of cervical mucus and the endometrium. The high efficacy and ease of maintenance make implants an ideal contraceptive for many women, including adolescents, a population that uses implants infrequently but reports high satisfaction. Implants are appropriate for women who are breastfeeding, who have contraindications to estrogen, or who have diseases such as diabetes, hypertension, sickle cell anemia, or an HIV infection because implants have few metabolic or hematologic effects. Long-term use has not been associated with a decrease in BMD and generally leads to increased blood levels and iron stores. Women who wish to space their pregnancies appreciate the nearly immediate onset of action with insertion and the rapid termination of all effects with removal. All types of implants lead to menstrual changes and other side effects in some women. Adverse effects that occur in implant users more than the general population include headaches and acne. Women must be thoroughly counseled regarding the potential for menstrual alteration, side effects, and sexually transmitted infections if they do not use condoms. Despite their initial high cost, implants are a cost-effective method over several years, even when discontinued before the life of the implant.
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Implantes de Medicamento , Adolescente , Muco do Colo Uterino/efeitos dos fármacos , Anticoncepcionais Femininos/efeitos adversos , Anticoncepcionais Femininos/farmacologia , Custos de Medicamentos , Feminino , Humanos , Ovulação/efeitos dos fármacos , Satisfação do Paciente , Gravidez , Congêneres da Progesterona/administração & dosagem , Congêneres da Progesterona/efeitos adversos , Congêneres da Progesterona/farmacologiaRESUMO
OBJECTIVE: The purpose of this study was to compare the abortifacient effect of intravaginally administered moistened misoprostol tablets with that of the combination regimen of mifepristone and oral misoprostol. STUDY DESIGN: One hundred women at =56 days' gestation received 800 microg misoprostol intravaginally in the form of sodium chloride solution-moistened tablets. The dose was repeated 24 hours later if a gestational sac persisted on ultrasonographic examination. These 100 subjects (group 1) were then matched with 100 subjects who had received 600 mg mifepristone followed by 400 microg misoprostol orally as part of a large multicenter American trial (group 2). Subjects were monitored for abortion success, adverse side effects, and bleeding characteristics. Abortion failure was defined as persistence of an intrauterine sac or the need to perform a surgical evacuation of the uterus for hemorrhage, for incomplete abortion, or at the subject's request. RESULTS: In 88 of the 100 women in group 1 and 94 of the 100 women in group 2, abortion occurred and a surgical procedure was not required. Abortion rates were not influenced by gestational age in either group. Prostaglandin-related side effects of fever and chills, vomiting, diarrhea, and uterine pain were all significantly higher in group 1. Excessive uterine bleeding was uncommon in both groups, and no subjects received blood transfusions. CONCLUSION: The abortion rate with intravaginally administered moistened misoprostol tablets is similar to that with the combination of mifepristone and oral misoprostol. However, intravaginal administration of misoprostol is associated with significantly more prostaglandin-related side effects.
Assuntos
Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Administração Intravaginal , Administração Oral , Adulto , Estudos de Coortes , Quimioterapia Combinada , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Cloreto de Sódio/administração & dosagem , Comprimidos , Resultado do TratamentoRESUMO
A study was undertaken to determine whether the combination of oral tamoxifen and moistened misoprostol administered vaginally was superior to that of placebo and moistened misoprostol administered vaginally for elective termination of early pregnancies.A clinical trial was conducted with a study group of 150 healthy women with pregnancies of =56 days gestational age who desired pregnancy termination. Subjects were randomized to ingest either 20 mg of tamoxifen (group 1) or placebo (group 2) twice daily for 1 day, followed 48 h later by vaginal administration of 800 micrograms of saline-moistened misoprostol. This dose of misoprostol was repeated 24 h later and 8 days later if an abortion had not occurred. The main outcome measures were incidence of complete abortion, hemoglobin levels, duration of vaginal bleeding, and incidence of side effects. Complete abortion occurred in 709 (93.3%) in group 1 and 68 (90.7%) in group 2. There were no differences in either group between earlier (=49 days) and later (50-56 days) gestations. The mean duration of uterine bleeding was 7.9 days and 8.2 days in group 1 and group 2, respectively. In group 1, 94.3% who aborted bled for <14 days, and in group 2, 95.6%. No subject required a blood transfusion. There were no significant differences in side effects between the two groups. These data suggest that pretreatment with tamoxifen is not necessary when using moistened vaginal misoprostol for abortion of pregnancies of =56 days of gestation.