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Termination and Contraceptive Options for the Cardiac Patient
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
CHCs should generally be avoided in women requiring anticoagulation. Beyond prothrombotic effect, CHCs can also interfere with hepatic metabolism of anticoagulants like warfarin, and therefore INR should be closely monitored if CHCs are used [60]. There is a theoretical risk of intramuscular hematoma formation with DMPA injection. Though no studies have specifically looked at this concern, a prospective series of women taking anticoagulation with a history of bleeding complications did not report any intramuscular hematomas [32]. It is thought that subdermal implants carry a lower risk, as hematomas would be more superficial and therefore easier to detect and monitor [3]. (See Box 5.4.)
Novel treatment modalities
Published in Seema Chopra, Endometriosis, 2020
Various progestins available for the treatment of endometriosis include NETA, CPA, MPA, DSG, ETG, LNG, and dienogest (DNG). These can be administered by different routes: orally, by depot subcutaneous injection, by subdermal implant, or by intrauterine device. Currently, the FDA has approved only depot MPA and NETA as monotherapies for the treatment of endometriosis [28]. The advantage of progestin alone over combination with estrogen is the lower thrombotic risk. Moreover, progestins are better tolerated than COCs in patients suffering migraine with aura and to those suffering migraine without aura in patients of less than 35 years of age, where COC are a relative contraindication [29]. Also progestins have a good tolerability profile with long-term use while spotting, breakthrough bleeding, depression, breast tenderness, and fluid retention are the most frequently encountered adverse events [24,29]. On comparing with other modalities, only MPA in a high dose (100 mg daily) was found to be more efficacious than the placebo. With respect to the route of administration, depot administration of progestins was not found to be superior to other treatments (low-dose COCs or LEU) in improving symptoms [30].
Teratogenicity and Registry Programs
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Reese L. Imhof, Megha M. Tollefson
In order to improve the iPLEDGE program, an emphasis on the effectiveness of contraceptives is recommended as well as the removal of requirements that do not effectively support the mission of the program. It has been suggested that iPLEDGE materials should be revised so that patients have access to clear information on how to avoid isotretinoin-associated birth defects with a focus on contraceptives that are most effective. For example, subdermal implants and intrauterine contraceptives are 20 times more effective than oral contraceptives. Providing information on the relative effectiveness of different contraceptive options could improve prevention of isotretinoin-exposed pregnancies (77).
Media Review: The Business of Birth Control
Published in Women's Reproductive Health, 2023
Describing the racist and eugenic nature of hormonal contraception administration, The Business of Birth Control does its best to do justice to the historical context of birth control in the USA. Chronologically jumpy, the narrative loops back to Margaret Sanger, the beginnings of Planned Parenthood, and the ethically unsound basis of the regulatory approval of the oral contraceptive pill. Instances of surgical sterilization of Mexican immigrants without patient consent, as recently as the 1960s, are reported. Equally horrifying are the descriptions of coerced subdermal implant insertions, using housing and welfare benefits as levers. This indelible past wields heavy influence in current SRH care experiences, and reinforces the importance of informed consent, transparency, and patient-centredness in even the most seemingly straightforward SRH consultation.
Localized, on-demand, sustained drug delivery from biopolymer-based materials
Published in Expert Opinion on Drug Delivery, 2022
Junqi Wu, Sawnaz Shaidani, Sophia K. Theodossiou, Emily J. Hartzell, David L. Kaplan
Nearly 80% of women from high-income countries have reported using oral hormonal contraceptive pills [32]. These hormones include androgens, estrogens, and/or progesterone. Combination pills that include both estrogen and progestin are associated with breakthrough bleeding, a twofold risk of myocardial infraction and stroke and a 37 times higher risk of venous thrombosis [32,33]. Additionally, contraceptive pills must be taken daily, leading to decreased patient compliance and drug effectiveness if the user forgets to take or misplaces the pills. Subdermal implants that achieve sustained, long-term systemic release of contraceptives were created to address these issues [34]. Nexplanon is an etonogestrel-releasing ethylene vinylacetate copolymer rod-shaped implant inserted subdermally in the arm, and can be left in place for 3 years via surgical incision [35]. If the patient sustains injuries near the implant site, however, the implant could be damaged and may require surgical removal [36]. Additional side effects associated with systemic subdermal contraceptives include menstrual disturbances, acne, headache, abdominal pain, hair loss, weight gain, and follicular cysts [34]. Currently, the most popular local contraceptive delivery systems are intrauterine devices (IUDs), which are used by more than 168 million women worldwide. However, IUDs also have complications such as causing infections, pelvic inflammatory disease, uterine perforation, and menstrual disturbances [37,38].
Etonogestrel-releasing contraceptive implant in a patient using thalidomide for the treatment of erythema nodosum leprosum: a case report
Published in Gynecological Endocrinology, 2022
Edson Santos Ferreira-Filho, Luis Bahamondes, Daniele Coelho Duarte, Ana Lúcia Monteiro Guimarães, Patrícia Gonçalves de Almeida, José Maria Soares-Júnior, Edmund Chada Baracat, Isabel Cristina Esposito Sorpreso
Although she was sexually active, she was not in use of any form of effective contraception. She had previously used combined oral contraceptives (levonorgestrel 0.15 mg + ethinyl estradiol 0.03 mg) and once-a-month injectable contraceptive (algestone acetophenide 150 mg + estradiol enanthate 10 mg); however, she discontinued both for personal reasons. She required a LARC method but, for personal reasons, she refused intrauterine contraception. After contraceptive counseling, she chose the subdermal implant. An ENG-implant (Implanon NXT, Merck, Os, The Netherlands) was placed in May 2017. Six weeks after concomitant use of thalidomide and ENG-implant, fasting blood samples were collected weekly, for four weeks, for serum gonadotropin and sex steroid measurement, by electrochemiluminescence immunoassay.