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Combined methods
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
The pill scare was related to three epidemiological studies (Jick et al., 1995; WHO, 1995; Spitzer et al., 1996) which showed that pills containing progestogen levonorgestrel, norethisterone or ethynodiol (which is converted to norethisterone) have an incidence of VTE for women of 5–7 per 10, 000 per year (BNF, 2019; FSRH, 2019d). Women using combined contraceptive methods containing etonogestrel or norelgestromin found in the vaginal ring have a 5–7 in 10,000 per year risk of venous thrombosis (BNF, 2019; FSRH, 2019d). For women taking pills containing progestogens gestodene or desogestrel the incidence doubles to 9–12 in 10,000 per year (BNF, 2019; FSRH, 2019d).. Research shows that levonorgestrel has the effect of opposing the oestrogenicity of the ethinyloestradiol and lowering sex hormone binding globulin, whilst combined pills containing the desogestrel raises sex binding globulin hormones allowing these pills to have increased oestrogenic effects which are associated with improvement of acne and increased prothrombotic coagulation changes (Guillebaud, 1999; Mackie et al., 2001).
Therapeutics in obstetrics and gynaecology
Published in Marwan Habiba, Andrea Akkad, Justin Konje, MRCOG Part 2, 2017
Marwan Habiba, Andrea Akkad, Justin Konje
F. COCP reduces milk production; this patient, despite having used the COCP successfully in the past, is a candidate for the POP. In the UK, progestogens used in oral POP are ethynodiol diacetate (Femulen®, Pharmacia), norethisterone (Micronor®, Janssen-Cilag), desogestrel (Cerazette®, Organon®) and levonorgestrel (Microval®, Wyeth and Norgeston®, Schering Health).
Fertility Control (Contraception and Termination of Pregnancy) – Answers
Published in Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth, Get Through, 2014
Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth
[Levonorgestrel, Norethisterone, Etynodiol acetate inhibits ovulation only in 40–60% of women and has alternative actions] [Desogestrel (Cerazette) inhibits ovulation in 97–99% of women] Mode of action: thickening of cervical mucus, endometrial atrophy and inhibition of ovulationIndicated when the COCP contraindicated: during lactation, during puerperium, sickle cell disease, SLE and other autoimmune diseaseSide effects: menstrual disturbance (irregular breakthrough bleeding is common with POPs), headaches, nausea, mood swings, abdominal bloating, breast tendernessInteractions: it does not interact with broad spectrum antibiotics, rifampicin or liver enzyme-inducing drugs, which can increase its metabolismWindow period Is narrow (3 hours) and therefore should be taken daily at the same hour. If POPs are started on day 1 of menstrual period, no extra contraception is required.If POPs are commenced after day 5 of menstrual period, extra contraception for 48 hours is necessary.Missed POP rules: If >3 hours late or >27 hours since the last dose, then take last pill as soon as possible and take subsequent pill at usual time (extra contraception is required for 48 hours).If vomiting occurs within 2 hours after ingestion then take another pill and extra contraception is required for 48 hours.
Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice
Published in Gynecological Endocrinology, 2023
Andrea R. Genazzani, Tiziana Fidecicchi, Domenico Arduini, Andrea Giannini, Tommaso Simoncini
Progestins are classified in categories according to their structural origins. They have been divided in generations according to the time of first synthesis. Among those used in the field of HC, pregnanes (17-hydroxyprogesterone derivatives and 19-norprogesterone derivatives, i.e. chlormadinone acetate) and estranes (testosterone derivatives, i.e. norethindrone, norethynodrel, norethindrone acetate, and ethynodiol diacetate) are considered first generation progestins. Only few of these are still used in HC due to their androgenic properties that cause bothersome side effects, as oily skin, acne, and reduced levels of high density lipoproteins (HDL) [30]. Second-generation progestins are called gonanes and derive from testosterone. This includes some of the most widely used progestins, such as levonorgestrel. Third generation include desogestrel, gestodene, norgestimate/norelgestromin, and etonogestrel. These molecules progressively lose the androgenic activity, acquiring a non-androgenic or an antiandrogenic effect. The newest progestins are the fourth-generation ones, that include nonethylated estranes (i.e. dienogest and drospirenone, a spironolactone derivative) and 19-norprogesterones-derivatives pregnanes (i.e. nomegestrol acetate) [29–31].
Effects of progestin-only contraceptives on the endometrium
Published in Expert Review of Clinical Pharmacology, 2020
Carlo Bastianelli, Manuela Farris, Vincenzina Bruni, Elena Rosato, Ivo Brosens, Giuseppe Benagiano
In the present review, we wish to revisit the third of these mechanisms, namely their action on the endometrium. This differs between the various families of synthetic compounds: derivatives of progesterone (among them, retro-progesterone, 19nor-progesterone, 17α-acetoxy-progesterone, 17α-cianomethyl-19nor-progesterone, medroxyprogesterone acetate, megestrol acetate, cyproterone acetate, trimegestone, dihydrogesterone); of 19nor-testosterone, subdivided into those derived from estrane (norethisterone, norethynodrel, norethisterone acetate, ethynodiol diacetate, lynestrenol, dienogest); gonane (levonorgestrel, gestodene, desogestrel, norgestimate); and spironolactone (drospirenone) (Figure 1).
Pharmacodynamics of combined estrogen-progestin oral contraceptives 3. Inhibition of ovulation
Published in Expert Review of Clinical Pharmacology, 2018
Carlo Bastianelli, Manuela Farris, Elena Rosato, Ivo Brosens, Giuseppe Benagiano
When translated to the situation in humans, Mishell and Odell [17] may have been the first to observe an luteinizing hormone (LH) surge at the beginning of treatment with ethynodiol diacetate compatible with the positive feedback theory. On the other hand, the inhibitory activity has been widely investigated; the first observed effect was a decrease or suppression of the mid-cycle LH surge [18,19].