Minipill contraceptive

The progestin-only Minipills tend to be less effective than combination OCs, and they are associated with irregular and unpredictable menstrual bleeding. They must be taken every day of the menstrual cycle at approximately the same time of day to maintain contraceptive efficacy. They are associated with more ectopic pregnancies than other hormonal contraceptives. 

Women who particularly benefit from progestin-only methods, including minipills, are those who are breast-feeding, those who are intolerant to estrogens, and those with concomitant medical conditions in which estrogen is not recommended. Also injectable and implantable contraceptives are beneficial for women with compliance issues. 

There is some delay in the return of fertility after discontinuation of oral contraceptive use. Gonadotropin profiles should be normal 3 months after combination oral contraceptive use is stopped. The incidence of prolonged amenorrhea extending beyond 6 months is 2 to 3%. This reaction is especially a problem with the use of progestin-only minipills. 

The minipill containing only a progestin, rather than a combination estrogen-progestin oral contraceptive, "was developed because progestin alone... 

In women for whom estrogens are contraindicated or undesirable, progestin-only contraceptives are an option. The progestin-only minipill may have enhanced effectiveness in nursing mothers and women over 40 in whom fertility may be decreased. 

The mechanism is unclear but they probably act by altering the endometriiun to prevent ovum implantation. Minipills are taken every day (there is no 7 day break in the cycle). Missed doses are treated as described for combination products above, except alternate forms of contraception are encouraged for two weeks after omission of two doses. Lack of estrogen may decrease side effects. Continued use may lead to amenorrhea and endometrial atrophy. 

The introduction of the minipill and the recognition that its contraceptive efficacy stems to large extent from its effect upon cervical factors has focused attention upon the vital role of the endocervical canal in human reproduction [175]. Like Janus, the old Roman god of doorways, the cervical structure mounts guard over the entrance to the interior of the female, controlling all that would enter and all that would leave. This is achieved ... 

Endocervical mechanisms of fertility control are characteristic of the luteal phase— the safe period —of the menstrual cycle and are also of paramount importance in the combination pill regimens [120] and in the various minipill regimens [137, 183, 184] and in the precoital use of progestagens [168]. It must be remembered, however, that the changes induced in endocervical mechanisms by progestagens are not yet fully understood and there is no doubt that gross examination of mucin is not a reliable guide to contraceptive action [145]. 

A dose relationship study withgChlormadinone ace gte (4) as a "minipill" had been published a clinical study of this antifertility agent, and a novel approach in the contraceptive field, a reverse-sequential regimen aimed to i prove the acceptability of 4 as a minipill has been described... 

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