Epilepsy, sexual development and the menstrual cycle
Timothy Betts, Lyn Greenhill in Managing Epilepsy with Women in Mind, 2005
Progestogens are also given as depot injections, subdermal implants or contained within an intrauterine system. Like the progestogen-only oral contraceptives, these drugs suppress endometrial proliferation and make cervical mucus hostile to sperm penetration. Depo-Provera (a depot injection) may also inhibit ovulation, possibly explaining why Depo-Provera has a higher contraceptive efficacy (about the same as that of combined oral contraceptives). Depo- Provera often causes amenorrhoea, although irregular or prolonged bleeding can occur. Heavy or irregular bleeding can occur in the first few months of Mirena coil use (a coil containing locally acting progesterone), but most women, even if this occurs, then find that menstrual loss is slight. The coil is not usually used until after the first pregnancy. Intrauterine device insertion occasionally leads directly to a seizure in women with epilepsy (whether this is a true reflex, a
Practice circuit 1
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith in Get Through MRCOG Part 3, 2019
Pre-pregnancy obstetric advice – specific to diabetes Contraception Stop the Depo-Provera as it may take up to 1 year for fertility to returnUse barrier contraception (or POP/COC) for the next 3 months to allow for folate supplementation and establishment of tight diabetic control.Check HbA1c levels – ideally pregnancy should be delayed until HbA1c <48 mmol/mol (6.5%).Tight blood sugar targetsDietary advice – dietician/nurse specialistAware of dangers of: Hypoglycaemia management must be reviewed particularly if switched on to insulin. Early morning hypoglycaemia is more common in early pregnancyHyperglycaemia and ketoacidosis
Contraception
James M. Rippe in Lifestyle Medicine, 2019
Depo-Provera, like other progestin-only contraception methods, alters the endometrial lining, thickens the cervical mucus, and blocks the luteinizing hormone surge to prevent ovulation. A backup form of contraception should be used if DMPA is given more than seven days from the start of menstrual bleeding.7 After discontinuation, ovulation resumes at 14 weeks, but it can take up to 18 months. In comparison with combined hormonal methods, Depo-Provera does not impact follicle-stimulating hormone levels as consistently or as intensely. Thus, for one-third of users, estradiol levels remain unchanged from early to mid-follicular phase levels.25
Blind to the Science: Contraceptive Risk and the Approval of Depo-Provera
Published in Women's Reproductive Health, 2018
Erin Ackerman
When the U.S. Food and Drug Administration (FDA) approved the injectable contraceptive Depo-Provera in 1992 for widespread use, its approval was hailed by FDA officials, physicians, and organizations such as Planned Parenthood as a gain for women. Depo-Provera would give women a wider range of birth control options, provide a convenient birth control method, and offer reliable protection by eliminating missed birth control doses. Critics, including other women’s health organizations, sounded a note of alarm about potential cancer and osteoporosis risks associated with the drug and how Depo-Provera might be used coercively to control the reproductive capacity of marginalized women, as had been the case with sterilization and other contraceptive methods such as Norplant. William Green’s Contraceptive Risk: The FDA, Depo-Provera, and the Politics of Experimental Medicine tracks the history of the development of Depo-Provera from its inception in the 1960s to its national approval in 1992. Green presents a compelling case that the FDA failed to protect women’s health in the approval of Depo-Provera, that this failure continues to jeopardize women’s health today, and that women cannot achieve redress because of the institutional limitations of the FDA and state and federal courts.
Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series (N = 24)
Published in Neuropsychological Rehabilitation, 2022
Glenn Kelly, Suzanne Brown, Lauren Gillett, Joseph Descallar, Grahame K. Simpson
No medication was prescribed to target the ISX behaviours, and a minority of the sample were prescribed other classes of medication, limiting the likelihood that medication played a role in the reductions of ISX behaviours. Depo-Provera (medroxyprogesterone acetate) is a common agent employed by forensic services to treat sex offenders in general (Nair, 2016). The treatment of sexual aggression using Depo-Provera among an uncontrolled case series of clients with ABI (n = 8) has been reported (Emory et al., 1995). Those behaviours included instances of paedophilia or rape, whereas the behaviours in the current case series were not as severe. The results of the current case series suggest that behaviour support interventions can be considered as an alternative to medication as a treatment option for most ISX behaviours after ABI.
Phase 1 study to investigate the pharmacokinetic properties of dacomitinib in healthy adult Chinese subjects genotyped for CYP2D6
Published in Xenobiotica, 2018
Xia Chen, Ji Jiang, Nagdeep Giri, Pei Hu
Eligible subjects had no evidence or history of clinically significant dermatologic, haematologic, renal, endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, neurologic, or allergic disease. Subjects were excluded if they had any condition possibly affecting drug absorption (e.g. gastrectomy), a history or evidence of drug dependency, a positive urine cotinine test at screening, a history of or regular alcohol consumption exceeding seven drinks/week for women or 14 drinks/week for men, or were unwilling to avoid beverages containing caffeine and/or alcohol or abstain from smoking. Prior use of an investigational drug or biologic within the three months preceding the first dose of study medication was not allowed. Concomitant treatment with prescription or nonprescription drugs and dietary supplements within 14 days or five half-lives, whichever was longer, before the first dose of study medication was not allowed. Herbal medication and hormone replacement therapy had to be discontinued at least 28 days before the first dose of study medication. In addition, Depo-Provera® had to be discontinued at least six months before the first dose of study medication.
Related Knowledge Centers
- Birth Control
- Estrogen
- Paraphilia
- Cancer
- Endometriosis
- Injection
- Hormone
- Progestogen
- Hormone Replacement Therapy
- Abnormal Uterine Bleeding