Contraceptives and

Table 2. Progestins Marketed in the United States and Europe for Contraceptive and Noncontraceptive Uses...

EthynodlolDia.ceta.te, Ethynodiol diacetate has been used alone, and in combination with an strogen, as an oral contraceptive and to treat disorders associated with progesterone deficiency (76). It may be crystallised from aqueous methanol (77) and is soluble in chloroform, ether, and ethanol sparingly soluble in fixed oils and insoluble in water (76). Extensive spectral and chromatographic data have been compiled (78). 

LynestrenoL Lynestrenol (73) has been used in oral contraceptives and to treat menstrual disorders. It is converted in vivo to its active metabohte norethindrone (102,103). It can be recrystallized from methanol, and is soluble in ethanol, ether, chloroform, and acetone, and insoluble in water (102). The crystal stmcture (104) and other spectral and analytical data have been reported for lynestrenol (62). 

The two synthetic steroidal estrogens which have attained the greatest degree of therapeutic use are ethinyl estradiol [57-63-6] (EE) (5) and its 3-methyl ether, mestranol [72-33-3]((5). In contrast to the naturally occurring estrone derivatives, these acetylenic analogues are orally active and are the main estrogenic components of combination oral contraceptives (see Contraceptives) and certain estrogen replacement products. 

L-Fohc acid is available as a crystalline dihydrate containing 8% water. Approximately 80% of the commercial production is consumed for feed enrichment in animal nutrition. FoHc acid is being offered by the pharmaceutical industry for therapeutic and prophylactic use (see Pharmaceuticals). Pharmacological doses of fohc acid are commonly used as a rescue dose during cancer chemotherapy, in women using oral contraceptives, and alcohoHcs. Several studies have provided evidence that multivitamins or foHc acid (0.8—4 mg/day) supplementation prevent the majority of neural tube defects (101). 

This article reviews various contraceptive methods, with particular emphasis on the evolution of the chemical methods used in current hormonal contraceptives and contragestational products, and describes research efforts directed toward the development of new approaches to control human fertihty. 

Areas of Continued Research. Research continues in many academic and pharmaceutical laboratories throughout the wodd with the objective of improving oral contraceptives and better understanding their pharmacological and clinical actions. 

Royal CoUege of General Practitioners, Oral Contraceptives and Health An Interim Report from the Oral Contraception Study, Pitman Medical, New York, 1974. 

Marchbanks PA, McDonald JA, Wilson HG et al (2002) Oral contraceptives and the risk of breast cancer. N Engl JMed 346 2025-2032... 

M ale and female hormones play a vital role because they aid in development and maintenance of secondary sex characteristics and are necessary for human reproduction. Although hormones are naturally produced by die body, administration of a male or female hormone may be indicated in the treatment of certain disorders, such as inoperable breast cancer, male hypogonadism, and male or female hormone deficiency. Hormones also are used as contraceptives and for treating the symptoms of menopause... 

Pitt, C. G., Marks, T. A., and Schindler, A., Biodegradable drug delivery systems based on aliphatic polyesters application to contraceptives and narcotic antagonists, in Controlled Release of Bioactive Materials (R. Baker, ed.). Academic Press, New York, 1980, pp. 19-43. 

Drug Interactions Carbamazepine induces the hepatic metabolism of many drugs, including other antiepileptic drugs, antipsychotics, some antidepressants, oral contraceptives, and... 

Discuss the risks associated with the use of contraceptives, and state absolute and relative contraindications to their use. 

List side effects associated with the use of various contraceptives, and recommend strategies for minimizing or eliminating such side effects. 

Provide appropriate patient education regarding the use of oral contraceptives, and... 

Cost is also another related issue for patients. Insurance may not cover all forms of contraception, and patients may have to bear the entire cost for certain options. 

As an alternative to hormonal contraceptives, several barrier contraceptive options are available for the prevention of pregnancy. While barrier contraceptives are associated with far fewer adverse effects compared with hormonal contraceptives, their efficacy is highly user-dependent. Overall, compared with both hormonal contraceptives and IUDs, barrier contraceptives are... 

TP, a 22 year-old woman, presents to your office for a routine gynecologic examination. She entered menarche at the age of 12. Her last menstrual period was 3 months ago. Her periods are often irregular and occur about every 2 to 3 months. She has had all normal Pap smears in the past and no history of sexually transmitted infections. She is currently in a monogamous relationship with a male partner. She has had a total of four sexual partners. She is not taking oral contraceptives and does not routinely use condoms. She has never been pregnant in the past, but she plans on starting a family in the near future. As you examine the patient, you note facial and chest acne, increased facial and abdominal hair, and obesity. 

Elevated estrogen levels, hormonal contraceptives, and pregnancy... 

A 22-year-old female college student with no remarkable medical history notes shortness of breath when she takes her daily 5-mile run, which has worsened progressively over the past 3 weeks. On review of systems, it is discovered that she has experienced intermittent sensations of chest tightness over the past 2 months that she ascribed to pollen allergies, and 3 days prior to presentation she experienced an episode of hemoptysis. Her only medication is oral contraceptives, and she reports no known drug allergies. A chest x-ray is remarkable for a 10 x 12 cm mediastinal mass. 

Riddle, J. M. (1992), Contraception and Abortion from the Ancient World to the Renaissance, Harvard Univ. Press, Cambridge, MA. 

Dickinson BD, Altman RD, Nielsen NH, Sterling ML Council on Scientific Affairs, American Medical Association Drug interactions between oral contraceptives and antibiotics. Obstet Gynecol 2001 98 853-860. 

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