Progestins adverse effects

Clinical studies also have been carried out with nonbio degradable implants releasing the progestin desogestrel (8). Unlike levonorgestrel, desogestrel possesses lower androgenic activity and thus has less adverse effect on blood Hpids. 

As with all medications, there are potential adverse effects with combined oral contraceptives (COCs). Many side effects can be minimized or avoided by adjusting the estrogen and/or progestin content of the oral contraceptive. It is also important to have proper patient selection for oral contraceptives because some women are at increased risk for potentially serious side effects. 

Pregnancy can be prevented following coitus by the administration of estrogens alone, progestin alone, or in combination ("morning after contraception). When treatment is begun within 72 hours, it is effective 99% of the time. Some effective schedules are shown in Table 40-4. The hormones are often administered with antiemetics, since 40% of the patients have nausea or vomiting. Other adverse effects include headache, dizziness, breast tenderness, and abdominal and leg cramps. 

The major adverse effects associated with the use of progestins are edema and depression. The androgen-like progestins can increase the ratio of LDL to HDL cholesterol, cause thrombophlebitis and pulmonary embolism, as well as acne, hirsutism and weight gain. 

Most adverse effects are believed to be due to the estrogen component, but cardiovascular effects reflect the action of both estrogen and progestin. The incidence of side effects with oral contraceptives is relatively low and is determined by the specific compounds and combinations used. 

Adverse effects. After long-term intake of estrogen/progestin preparations, increased risks have been reported for breast cancer, coronary heart disease, stroke, and thromboembolism. Although the incidence of bone fractures also decreases, the risk-benefit relationship is unfavorable. Concerning the adverse effects of oral contraceptives, see p. 252. 2005 Thieme and conditions of license. 

Women with secondary amenorrhea who have been estrogen deficient for 12 months or longer also should be given low-dose estrogen replacement initially to avoid adverse effects such as mastalgia and nausea. However, the dose can be titrated up to maintenance levels over a 6-month period, and progestin therapy can be instituted with the initiation of estrogen therapy. Women with a brief history of sec-... 

The progestin-like drugs, their use in contraception and in hormonal replacement therapy, and their j adverse effects are considered. 

Although the adverse effects of OC therapy include an increased risk of stroke, acute myocardial infarction, and venous thromboembolic disease, the incidence of cardiovascular disease in this patient population (age, <35 years) is already low (66). In women older than 35 years, the natural incidence of cardiovascular disease increases, so these adverse effects become more important to consider. From a metabolic perspective, the primary adverse effect of the estrogen component is an increase in hepatic production of proteins, including those that enhance venous and arterial thromboembolism (70). In addition, the progestin component has an adverse effect... 

Several subdermal implants are available that provide contraceptive efficacy for 1 to 5 years depending on the formulation (Table 46.10). These implants consist of progestins contained within individual rods that are surgically implanted into the upper arm. As indicated in Table 46.10, varying durations of action can be expected depending on the number of rods implanted. Currently, Norplant is not available in the United States, and Implanon has only received approval" status by the U.S. FDA. These formulation is subject to the same adverse effects as other progestin-only methods. 

Medroxyprogesterone acetate (Fig. 46.13), administered by injection (Depo-Provera), orally, or delivered via lUD, effectively suppresses the HPO axis, induces anovulation, and reduces serum estrogen levels (83). This prevents menstruation and endometrial implant growth. As a result, endometriosis-related pain is minimized in approximately 90% of the patients. Drug therapy selection should reflect the fact that pharmacological therapy is likely to be required on a chronic basis. The progestins are fairly well tolerated and relatively inexpensive, but they are not without adverse effects. 

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