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Case 40
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
The basic options available to any patient areIntrauterine contraceptives (long-acting reversible contraception)Copper-containing intrauterine contraceptive device (copper coil)Levonorgestrel releasing intrauterine system (e.g. Mirena® or Jaydess®)Progestogen-only contraceptionImplantDepot injectionProgestogen-only pillCombined hormonal contraceptionCombined oral pillTransdermal patchesVaginal rings
Therapeutics in obstetrics and gynaecology
Published in Marwan Habiba, Andrea Akkad, Justin Konje, MRCOG Part 2, 2017
Marwan Habiba, Andrea Akkad, Justin Konje
F. This patient is a candidate for progestogen-only contraception. The presence of a fibroid uterus presents an added difficulty. As she is uncertain of her plans for pregnancy and given her age, long-term depot preparations may not be ideal.
Contraception and abortion
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
The injectable, implant and desogestrel-containing POP inhibit ovulation. Lower-dose POP formulations inhibit ovulation only inconsistently. All progestogen-only contraceptive methods, regardless of the route of administration, thicken cervical mucus so reducing sperm penetrability and transport. The levonorgestrel intrauterine system (LNG-IUS) has little effect on ovarian activity but causes marked endometrial atrophy, which prevents implantation if ovulation and fertilization occur.
Bleeding profile of women with cardiovascular risk factors using a drospirenone only pill with 4 mg over nine cycles compared to desogestrel 0.075 mg
Published in Gynecological Endocrinology, 2022
Pedro-Antonio Regidor, Santiago Palacios, Enrico Colli
The lactation period is also a situation where progestogen-only contraception confers a significant additional benefit as no reduction in milk production and no adverse effects on the newborn are anticipated with their use. Due to their decidualization transformation on endometrial cells and their antimitotic mode of action, progestogens can reduce the frequency and intensity of uterine bleeding. It has also been described that those progestogens that exhibit a central ovulation inhibition ability reduce painful menstrual bleedings by blocking the synthesis of prostaglandins in the endometrium [6,7].
A clinical observational study on the efficacy of subcutaneous etonogestrel implants for adenomyosis in 20 patients
Published in Gynecological Endocrinology, 2021
Lekai Nie, Hongli Zou, Xiaotian Ma, Lei Cheng, Jun Jiao, Fenghua Wang, Weifeng Liang, Peihai Zhang
Changes in the menstrual bleeding pattern are the most common adverse effects of progestogen-only contraception. Progestogen may affect abnormal endometrial angiogenesis, which plays a role in the integrity of spiral arterioles by altering their basement membranes and pericytes [19]. Bleeding pattern changes were reported in all clinical studies about etonogestrel implant. In this study, patients had irregular menstrual patterns, but these changes could be acceptable when the decreasing menstrual volume was considered.
Reproductive health in adults with congenital heart disease: a review on fertility, sexual health, assisted reproductive technology and contraception
Published in Expert Review of Cardiovascular Therapy, 2023
J.A. van der Zande, G. Wander, K.P. Ramlakhan, J.W. Roos-Hesselink, M.R. Johnson
Contraception should be discussed in teenagers and young adults with CHD to avoid unplanned pregnancy because of the increased risk of maternal morbidity and mortality, but also to avoid complications of specific contraceptive methods. Barrier methods have a relative high failure rate and are not considered sufficient alone but are valuable in combination with other methods as they offer protection from sexually transmitted diseases [83,84]. Estrogens are pro-thrombotic via the increased hepatic production of coagulation factors, which makes contraception containing estrogens (combination pills, patches, or rings) unsuitable for women with CHD, as these women already have an increased risk for thromboembolic events [6,83,85]. In addition, in women with mild hypertension (>140/90 mm Hg), estrogen-containing contraceptives are relatively contraindicated, and absolutely contraindicated in women with uncontrolled hypertension (>160/100 mm Hg). In women with CHD, progesterone-only contraceptive methods are considered safe, as they have no effect on the coagulation cascade and blood pressure [83,85]. The potential side effects of progestogen-only contraception, such as irregular bleeding patterns and continuous spotting, should be discussed to improve compliance. In women with CHD who are on anticoagulation, long-acting reversible contraceptives, especially subdermal implants or Levonogestrel-IUD, are the methods of choice. Importantly, in patients with preload-dependent conditions, such as pulmonary arterial hypertension, severe valvular stenosis, or a Fontan circulation, it is recommended to insert and remove an IUD with cardiovascular monitoring and appropriate pain relief, as pain can elicit a vagal reaction [86]. Taking this into account, subdermal implants may be more suitable for women with preload-dependent conditions, as these are easily inserted under local anesthesia [83]. Antibiotic prophylaxis is not recommended during insertion of an intrauterine device as stated by the ESC guidelines for infective endocarditis [57].