Contraceptives, hormonal types

Q10 When choosing an oral contraceptive, a preparation with the lowest oestrogen and progestogen content that can control the cycle is selected. In older women or women with a history of venous thrombosis who require contraception, a progestogen-only preparation may be more suitable than the combined hormonal type, but unfortunately this is not a suitable choice for Shabana s problem. 

Estrogens and progestins (combination oral contraceptives) are used as oral contraceptives. There are three types of estrogen and progestin combination oral contraceptives monophasic, biphasic, and triphasic. The monophasic oral contraceptives provide a fixed dose of estrogen and progestin throughout the cycle The biphasic and triphasic oral contraceptives deliver hormones similar to the levels naturally produced by the body (Table 52-1). 

Efforts to improve IUDs have led to the use of medicated devices. Two types of agents are generally used—contraceptive metals and steroid hormones. The metal device is exemplified by the CU-7, a polypropylene plastic device in the shape of the number 7. Copper is released by a combination of ionization and chelation from a copper wire wrapped around the vertical limb. This system is effective for up to 40 months. 

Conflicting data concerning the effects of oral contraceptives on carbohydrate metabolism have been presented the effects are probably clinically insignificant. However, estrogen hormone replacement therapy with a sequential-type product containing mestranol and norethisterone caused significantly impaired glucose tolerance (30). 

Suggestive case histories raised at an early phase the notion of a possible correlation of oral contraceptives with endometrial cancer. Among cases of endometrial cancer there seemed to be an excess of users of oral contraceptives, particularly of the early high-dose estrogen type. With the virtual demise of these early products, the situation seems to have reversed a 1983 study from the Centers for Disease Control (CDC) in Atlanta showed that women who had used fixed combinations for oral contraception at some time in their lives had a relative risk of endometrial cancer of only 0.5 compared with never-users (112). The protective effect occurred only in women who had used oral contraception for at least 12 months, and lasted for at least 10 years after withdrawal. The WHO adopted the same view in 1988 in the light of multinational data (113). As in the case of hormonal replacement therapy, the protective effect seems to be due to the progestogen component. 

Some limitations are that the amount of drug that can be injected in this fashion is fairly small and that the injected drug must not irritate or inflame the subcutaneous tissues. The subcutaneous route can also be used when certain types of drug preparations are implanted surgically beneath the skin, so that the drug is slowly dispersed from the implanted preparation and then absorbed into the bloodstream for prolonged periods of time.62,86 A common example of this form of subcutaneous administration is the use of implanted hormonal contraceptive products (e.g., Norplant).9,53 The use of these implantable contraceptives is discussed in more detail in Chapter 30. 

When acne is severe it may require medidnes that have to be taken by mouth and these may be stronger antibiotics combined with hormone therapy. Tetracyclines and erythromycin are typically used and they have to be taken for many weeks, but there are signs that bacteria are becoming resistant to these antibiotics and if there is no improvement in the acne within three months then this type of treatment has to be discontinued, or a much stronger antibiotic tried. Hormone therapy is available for young women with severe acne and this can block the sebum-stimulating effect of natural hormones - as well as having a contraceptive effect. 

Donaghy M, Chang CL, Poulter N et al. (2002). European Collaborators of the World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Duration, frequency, recency, and type of migraine and the risk of ischemic stroke in women of childbearing age. Journal of Neurology, Neurosurgery and Psychiatry 73 747-750... 

The hypercoagulability that can occur with conjugated estrogens has been reported to be less pronounced than with oral contraceptives, but it is not clear that it is less than that seen with other types of estrogen used in hormone replacement therapy (36). The hematological effects of different estrogens are additive various reports have demonstrated this for ethinylestradiol and diethylstilbestrol... 

Spermicidal condoms emd intrauterine devices (lUDs) contmning copper or a hormone are medicines, whereas non-spermicidal condoms and other barrier-type contraceptives (e.g., diaphragms) cire medical devices. 

The book is organised into 34 chapters, arranged in 10 sections based on body systems (e.g. respiratory) or types of condition (e.g. fungal infections), plus a section dealing with women s conditions that includes a chapter on emergency hormonal contraception (Chapter 32). 

In a lawsuit involving the Ortho Pharmaceutical Corporation, the issue was whether Ortho s norgestimate infringed the patentee s claims to norgestrel under the doctrine of equivalence.5 Both compounds are progestin-type steroid hormones used as oral contraceptives. The two compounds share the same fused ring core... 

Currently, the most effective method to prevent conception is by oral steroid hormone treatment (Figure 34-9) to inhibit or modify the cyclic changes in endogenous reproductive hormones. Two effective types of oral contraceptives are used with proven success one to prevent ovulation, the other to prevent implantation. 

Rifampin s potent induction of hepatic enzymes, especially cytochrome P450 (CYP) 3A4, may enhance the ehmination of many other drugs, most notably the protease inhibitors used to treat HIV (Table 110-7). HIV-positive patients may beneht from the use of rifabutin instead of rifampin (see below). ° Also, women who use oral contraceptives must use another form of contraception during therapy because increased clearance of the hormones may lead to unexpected pregnancies. Patient records should be reviewed for potential drug interactions before dispensing rifampin. Rifampin may turn urine and other secretions orange-red and may permanently stain some types of contact lenses. 

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