Minipills

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. 

Minipill. Continuous low-dose administration of progestin alone can prevent conception. Ovulations are not suppressed regularly the effect is then due to progestin-induced alterations in cervical and endometrial function. Because of the need for constant intake at the same time of day, a lower success rate, and relatively frequent bleeding anomalies, these preparations are now rarely employed. 

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... 

Inducing other changes in the uterine mucosa which may be unfavourable for the implantation of fertilized ovum. This action is important in minipills and postcoital pills. 

Landgren BM. In Gestagen Methods (Depo-Provera, Minipill and Norplant). Uppsala Swedish Medical Products Agency, 1994 2. 

Women with migraine headaches, history of thromboembolic disease, heart disease, cerebrovascular disease, SEE with vascular disease, and hypertriglyceridemia are good candidates for progestin-only methods (e.g., minipills, DMPA, and the levonorgestrel intrauterine system). Women older than 35 years who are smokers or are obese, or who have hypertension or vascular disease, should use progesterone-only methods. 

Minipiles, those smaller in diameter than about 10 inches, function the same as larger piles. They are particularly suited in places where operating headroom is low, and where conventional pile driving equipment will not fit. They, too, will density granular deposits as they are driven. However, their small cross sectional area makes them unsuitable for (load bearing) sand piles. The smaller sizes, however, are filled with uncompacted, narrowly graded sand in clay deposits, to create sand drains. 

Minipiles function similarly to larger piles, and are of major use in places where headroom is limited, and large equipment can t be accommodated. Their small cross-sectional area, however, makes them unsuitable for sand piles. 

Why would minipiles be used instead of larger piles ... 

None Formulations with progestin only (minipill) Norethindrone 35 Micronor... 

Progestin-only minipill preparations do not increase thromboembolic events or blood pressure or cause nausea and breast tenderness. Acne may result from the androgenic activity of norethin-drone-containing preparations. These preparations may be attractive for nursing mothers because they do not decrease lactation as do products containing estrogens. 

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. 

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