Bleeding vaginal

Clinical studies with Norplant attest to its high contraceptive efficacy and safety. The main reason patients request the removal of Norplant is unpredictable vaginal bleeding episodes followed by amenorrhea. The bleeding problem is an unavoidable sequela of progestogen-only contraception. 

Female patient If pregnancy is suspected or abnormal vaginal bleeding occurs, stop taking die drug and contact die primary healdi care provider immediately. 

Report adverse reactions such as fluid retention or edema to the extremities weight gain pain, swelling, or tenderness in die legs blurred vision chest pain yellowed skin or eyes dark urine or abnormal vaginal bleeding. 

Hot flushes, nausea, vomiting, vaginal bleeding, vaginal discharge, menstrual irregularities, skin rash... 

Irregular, heavy, or prolonged vaginal bleeding, perimenopausal symptoms (hot flashes, etc.)... 

HRT should not be prescribed to women with a history of or active thromboembolic disease, breast cancer or estrogen-dependent neoplasm, pregnancy, liver disease, or undiagnosed vaginal bleeding. It also should not be used for the prevention or treatment of cardiovascular disease, cerebrovascular disease, or dementia.11... 

Megestrol RCT in breast cancer patients demonstrating up to 80% reduction in hot flashes 20-40 mg daily Vaginal bleeding, headache, weight gain, thromboembolism, edema... 

Endometrial studies in women with undiagnosed vaginal bleeding... 

Toremifene is an estrogen receptor antagonist. The pharmacokinetics of toremifene are best described by a two-compartment model, with an a half-life of 4 hours and an elimination half-life of 5 days. Peak plasma concentrations are achieved approximately 3 hours after an oral dose. Toremifene is metabolized extensively, with metabolites found primarily in the feces. Toremifene is used for the treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor-positive or unknown tumors. Toremifene causes hot flashes, vaginal bleeding, thromboembolism, and visual acuity changes. 

Progestins Megestrol acetate Med roxyp rogestero ne 40 mg orally four times daily 400-1000 mg IM every week Weight gain, hot flashes, vaginal bleeding, edema, thromboembolism... 

The degree of abdominal swelling secondary to fluid accumulation may present like "pregnant abdomen" with irregular vaginal bleeding. 

Tamoxifen -nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -endometrial carcinoma -vaginal bleeding -venous thrombosis... 

Cholestatic jaundice of pregnancy Irregular or heavy vaginal bleeding severe dysmenorrhea... 

Gastritis Hemorrhoids Chronic hemorrhage Vaginal bleeding Peptic ulcer Intestinal parasites... 

Tamoxifen is usually well tolerated. Symptoms of estrogen withdrawal (hot flashes and vaginal bleeding) may occur but decrease in frequency and intensity over time. Tamoxifen increases the risks of stroke, pulmonary embolism, deep vein thrombosis, and endometrial cancer, particularly in women age 50 years or older. 

Less than one-half of patients develop symptoms of recurrence such as pain syndromes, changes in bowel habits, rectal or vaginal bleeding, pelvic masses, anorexia, and weight loss. CEA levels may help detect recurrences in asymptomatic patients. 

Fig. 11.2. Percentage of women who referred to vaginal bleeding or spotting previous to treatment and after 6 months of treatment with Raloxifene or continuous combined therapy with 2 mgr of 17B-estradiol and 1 mgr of noretisterone acetate (Neven et al. 2003)...

When rats were fed 6 mg/kg/day heptachlor (98% purity) for an unspecified portion of an 18-month study, there was a 23% decrease in size of successive generations (Mestitzova 1967). Vaginal bleeding was reported in rats fed 1.28 mg/kg/day heptachlor for 80 weeks (NCI 1977). 

Cytotec containing misoprostol (prostaglandin analogue) may cause abnormal vaginal bleeding. 

Combined oral contraceptives are less likely to be associated with irregular vaginal bleeding than progestogen-only contraceptives. However, they are... 

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