Patrón de sangrado uterino en adolescentes usuarias de implante anticonceptivo subdérmico de etonogestrel / Uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant

Objetivo: Describir las características del patrón sangrado uterino de las adolescentes que usan el implante anticonceptivo sudérmico de etonogestrel (IASE) que concurren a un centro especializado en salud sexual y reproductiva de adolescentes en Santiago, Chile, y su asociación con variables biopsicosocial. Método: Estudio de cohorte retrospectiva de las usuarias de IASE. Los datos fueron analizados utilizando la ecuación de estimación generalizada, análisis de sobrevida de Kaplan Meier y test de log-rank. Resultados: La cohorte incluyó a 62 adolescentes. La media de edad fue de 16,2 años. Las participantes recibieron asesoramiento anticonceptivo antes de la inserción del IASE, y fueron seguidas durante tres años. Los patrones de sangrado más frecuentes durante el primer año fue el de amenorrea (40,5%) y el sangrado aceptable (27,1%), mientras que el menos frecuente fue prolongado y/o sangrado frecuente (15,8%). De acuerdo con el análisis de sobrevida, la única variable biopsicosocial asociado con patrón prolongado y/o sangrado frecuente fue condición médica previa. Cinco adolescentes (8%) se retiraron el IASE. Conclusiones: El IASE es una opción anticonceptiva segura y altamente eficaz para las adolescentes, independientemente de la paridad. La consejería es de gran importancia para fomentar la tolerancia y la adhesión al implante.

Objectives: To describe uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant (ENG implant) attending a specialized adolescent sexual and reproductive health centre in Santiago, Chile, and test their association with bio-psychosocial variables. Methods: A retrospective cohort study of ENG implant users was conducted and data were analysed using the Generalized Estimating Equation, Kaplan Meier Survival Analysis and Log-Rank Test. Results: The cohort included 62 adolescents with and average age at inclusion of 16.2 years. Participants received contraceptive counselling prior to insertion of an ENG implant, and were followed up for three years. The most frequent bleeding patterns during the first year were amenorrhea (40.5%) and acceptable bleeding (27.1%), whilst the least frequent was prolonged and/or frequent bleeding (15.8%). According to the survival analysis, the only bio-psychosocial variable associated with prolonged and/or frequent bleeding was prior medical condition. Five adolescents (8%) withdrew from the treatment. Conclusions: The ENG implant is a safe and highly effective contraceptive option for adolescents, regardless of parity. Counselling is of great importance to foster tolerance and adherence to the ENG implant.

[Efficacy of foeniculum vulgare mill extract on menstrual bleeding over the students of Shahid Beheshti University in Tehran 2005]

Menstrual bleeding is a reaction of periodic falling secretary endometrial for the reason that decreases production of estradiol and progesterone. In traditional medicine, Foeniculum vulgare Mill is used as a tonic, sedative, galactogogue drug and increases menstrual bleeding. This study aimed to determine efficacy of Foeniculum vulgare Mill extract on menstrual bleeding severity and duration over the students of Shahid Beheshti University in Tehran 2005. This study was done as a placebo-control, double blind, randomized clinical trial. Bleeding severity and duration was assessed at baseline and throughout two menstrual cycle of the investigation using validated questionnaires. Ninety women, completed the study [n=46 treatment group, n=44 placebo group]. The medicines capsules containing 46mg of Foeniculum vulgare Mill extract in treatment group, and same shape placebo capsules in placebo group, administered as soon as onset of pain feeling or bleeding, five capsules a day and continued for at least three days. The data analysis with repeated measurements showed that after treatment in none of groups, average of menstrual bleeding severity and duration in comparison with before the treatment did not increase and there was no significant difference between two groups. This study suggested that Foeniculum vulgare extract and placebo do not increase menstrual bleeding severity and duration. Studies showed that Foeniculum vulgare essential oil has ability to inhibit uterus contractions and increase menstrual bleeding, but this study showed that the extract had no effect on menstrual bleeding

Prevention and treatment of vaginal bleeding after drug-induced abortion by Yaoliuan capsule and its effects on menses recovery / 华中科技大学学报（医学）（英德文版）

In order to explore the effect of Yaoliuan capsule in the prevention and treatment of vaginal bleeding after drug-induced abortion and menses recovery after drug-induced abortion, 323 cases of gestation period < or = 49 days and without contraindication, were divided randomly into study group (168 cases, taking Yaoliuan capsule) and control group (155 cases, taking placebo capsule). The results showed that in the study group, there were 161 cases (95.8%) of complete abortion, 7 cases (4.2%) of incomplete abortion; In the control group, there were 146 cases (94.2%) of complete abortion, 6 cases (3.9%) of incomplete abortion, 3 cases (1.9%) of abortion failure. The vaginal bleeding time was 5-25 days (mean 10.8 days) in study group, while that was 6-62 days (mean 19.1 days) in control group. The menstrual cycle was 30.5+/-5. 2 days and 33.8 d+/-8.6 days respectively in study and control groups. The menstrual period was 6.1+/-3. 5 days and 9.9+/-5.1 days respectively in study and control groups. Yaoliuan capsule is an effective drug to prevent and treat vaginal bleeding following drug-induced abortion, promote menstruation recovery and prevent pelvic infection.

Luteal phase contraception with mifepristone (RU 486) in the rhesus monkey.

Mifepristone (RU 486), an antiprogesterone, is a promising luteal phase contraceptive agent for human use. However, at present its use is limited by the practical constraint of determining the day of ovulation for an LH + 2 day administration of the drug as indicated from experimental and clinical studies. The aim of the present study was to identify the effective period of luteal phase (luteal phase window) when a single administration of mifepristone would induce antinidatory activity without disturbing menstrual cyclicity and ovulatory pattern in the rhesus monkey. RU 486 (2 mg/kg body weight in benzyl benzoate/olive oil, 1:3) was given to mated monkeys (n = 9) on cycle day 16 in the first treatment cycle (treatment group T1, n = 9), and in the following cycle on cycle day 20 (treatment group T2, n = 8). A single s.c. injection of this antiprogestin during early to midluteal phase (days 1-10 after ovulation, as determined from retrospective analysis of serum concentrations of estrogen and progesterone) provided a one hundred per cent protection against pregnancy, with no apparent side effects. There were no changes in cycle lengths (F = 3.5; P < 0.3), day of ovulation (F = 1.8; P < 0.7) and duration of menses (F = 3.5; P < 0.3) compared with the pre-treatment and post-treatment cycles. Pooled analyses of serum concentrations of estrogen and progesterone during luteal phases of T1 and T2 cycles also showed no variations with those in pre- and post-treatment cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices

The effects of a fibrinolysis inhibitor [tranexamic acid, TA] and prostaglandin synthesis inhibitor [diclofenac sodium, DS] were compared in the reduction of excessive menstrual blood loss in 19 women with an intrauterine contraceptive device [IUCD]. These women [mean blood loss before treatment to 135. 1 + 18.9 SE ml, range 70-294 ml] were treated in random order with TA [1.5g three times daily for 5 days starting on the first day of menstruation for two periods], and with DS [50 mg three times on the first day followed by 25 mg three times daily for 4 days, for two periods], or with placebo [one period] in a double-blind trial. The placebo treatment did not change menstrual blood loss [128.3 + 15.6 ml]. The T A treatment decreased blood loss to 59.4+7.7 ml [P<0.001] and the DS treatment to 102.1 + 13.6 ml [P<0.01]. Neither treatment abolished pelvic discomfort during menstruation or shortened its duration. Various side-effects were noted by 12 women during 19 TA treatments and by five women during six DS treatments. Thus, while TA is generally far more effective, DS gave pronounced decreases in menstrual bleeding in some women and had less frequent side-effects

Efficacy and menstrual performance with the continuous and interrupted vaginal administration of combined contraceptive pills

Neolar [5 ug ethinyl estradiol + 250 ug levonorgestrel] was used for contraception by 100 women who inserted the pill in the vagina. Forty four women used it continuously for one year while 56 women used it intermittently for 21 days on and 7 days off 12 cycles. Both groups were assigned to monthly follow up visits. The idea was to study whether the continuous administration would have any acceptability merits. The study confirmed the contraceptive efficacy of vaginal administration of combined pills; one pregnancy occurred in 1026 cycles studied. The continuous regimen was associated with a significantly higher incidence of amenorrhea, the majority of women expressed their uneasiness and apprehension about it. Break-through bleeding was also commoner with the continuos use regimen. This suggests that the interrupted regimen will be more acceptable in the Egyptian culture

Further study on the effect of norethisterone enanthate, an injectable contraceptive on body functions.

One hundred and fortythree healthy Bengali women have received norethisterone enanthate, as injectable contraceptive in doses of 200 mg. intramuscularly at intervals of 10 to 12 weeks. The drug have been found to be almost 100 percent effective in the control of fertility. Menstrual disturbance, e.g. amenorrhoea, irregular bleeding and spotting, appeared to be the main complaints of the clients during the initial period of the therapy; but these did not persist long. There was no ill effect of the drug on lactation. No significant change in body weight, blood pressure, platelet count, fasting blood sugar, serum cholesterol and total plasma protein level was observed following administration of norethisterone enanthate over one year.