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[PMID]: 25611781
[Au] Autor:Kumar V; Johnson AC; Trubiroha A; Tumová J; Ihara M; Grabic R; Kloas W; Tanaka H; Kroupová HK
[Ad] Address:Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Research Institute of Fish Culture and Hydrobiology, University of South Bohemia in Ceske Budejovice , Zatisi 728/II, 389 25 Vodnany, Czech Republic.
[Ti] Title:The challenge presented by progestins in ecotoxicological research: a critical review.
[So] Source:Environ Sci Technol;49(5):2625-38, 2015 Mar 03.
[Is] ISSN:1520-5851
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Around 20 progestins (also called gestagens, progestogens, or progestagens) are used today in assisting a range of medical conditions from endometrial cancer to uterine bleeding and as an important component of oral contraception. These progestins can bind to a wide range of receptors including progestin, estrogen, androgen, glucocorticoid, and mineralocorticoid receptor, as well as sex hormone and corticosteroid binding globulins. It appears that only five of these (four synthetic and one natural) progestins have so far been studied in sewage effluent and surface waters. Analysis has reported values as either nondetects or low nanograms per liter in rivers. Seven of the progestins have been examined for their effects on aquatic vertebrates (fish and frogs). The greatest concern is associated with levonorgestrel, norethisterone, and gestodene and their ability to reduce egg production in fish at levels of 0.8-1.0 ng/L. The lack of environmental measurements, and some of the contradictions in existing values, however, hampers our ability to make a risk assessment. Only a few nanograms per liter of ethynodiol diacetate and desogestrel in water would be needed for fish to receive a human therapeutic dose for these progestins according to modeled bioconcentration factors. But for the other synthetic progestins levels would need to reach tens or hundreds of nanograms per liter to achieve a therapeutic dose. Nevertheless, the wide range of compounds, diverse receptor targets, and the effect on fish reproduction at sub-nanogram-per-liter levels should prompt further research. The ability to impair female reproduction at very low concentrations makes the progestins arguably the most important pharmaceutical group of concern after ethinylestradiol.
[Mh] MeSH terms primary: Ecotoxicology/methods
Ecotoxicology/standards
Progestins/toxicity
Water Pollutants, Chemical/toxicity
[Mh] MeSH terms secundary: Animals
Fishes
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Name of substance:0 (Progestins); 0 (Water Pollutants, Chemical)
[Em] Entry month:1511
[Cu] Class update date: 150303
[Lr] Last revision date:150303
[Js] Journal subset:IM
[Da] Date of entry for processing:150123
[St] Status:MEDLINE
[do] DOI:10.1021/es5051343

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[PMID]: 25085875
[Au] Autor:Beaber EF; Buist DS; Barlow WE; Malone KE; Reed SD; Li CI
[Ad] Address:Group Health Research Institute, Group Health Cooperative, Seattle, Washington. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Department of Epidemiology, University of Washington, Seattle, Washington. ebeaber@fhcrc.org.
[Ti] Title:Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age.
[So] Source:Cancer Res;74(15):4078-89, 2014 Aug 01.
[Is] ISSN:1538-7445
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Previous studies of oral contraceptives and breast cancer indicate that recent use slightly increases risk, but most studies relied on self-reported use and did not examine contemporary oral contraceptive formulations. This nested case-control study was among female enrollees in a large U.S. integrated health care delivery system. Cases were 1,102 women ages 20 to 49 years diagnosed with invasive breast cancer from 1990 to 2009. Controls were randomly sampled from enrollment records (n = 21,952) and matched to cases on age, year, enrollment length, and medical chart availability. Detailed oral contraceptive use information was ascertained from electronic pharmacy records and analyzed using conditional logistic regression, ORs, and 95% confidence intervals (CI). Recent oral contraceptive use (within the prior year) was associated with an increased breast cancer risk (OR, 1.5; 95% CI, 1.3-1.9) relative to never or former OC use. The association was stronger for estrogen receptor-positive (ER(+); OR, 1.7; 95% CI, 1.3-2.1) than estrogen receptor-negative (ER(-)) disease (OR, 1.2, 95% CI, 0.8-1.8), although not statistically significantly different (P = 0.15). Recent use of oral contraceptives involving high-dose estrogen (OR, 2.7; 95% CI, 1.1-6.2), ethynodiol diacetate (OR, 2.6; 95% CI, 1.4-4.7), or triphasic dosing with an average of 0.75 mg of norethindrone (OR, 3.1; 95% CI, 1.9-5.1; Pheterogeneity compared with using other oral contraceptives = 0.004) was associated with particularly elevated risks, whereas other types, including low-dose estrogen oral contraceptives, were not (OR, 1.0; 95% CI, 0.6-1.7). Our results suggest that recent use of contemporary oral contraceptives is associated with an increased breast cancer risk, which may vary by formulation. If confirmed, consideration of the breast cancer risk associated with different oral contraceptive types could impact discussions weighing recognized health benefits and potential risks.
[Mh] MeSH terms primary: Breast Neoplasms/epidemiology
Contraceptives, Oral/administration & dosage
Contraceptives, Oral/chemistry
[Mh] MeSH terms secundary: Adult
Breast Neoplasms/chemically induced
Case-Control Studies
Contraceptives, Oral/adverse effects
Female
Humans
Middle Aged
Risk Factors
United States/epidemiology
Young Adult
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Name of substance:0 (Contraceptives, Oral)
[Em] Entry month:1502
[Cu] Class update date: 170220
[Lr] Last revision date:170220
[Js] Journal subset:IM
[Da] Date of entry for processing:140803
[St] Status:MEDLINE
[do] DOI:10.1158/0008-5472.CAN-13-3400

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[PMID]: 24226383
[Au] Autor:Grimes DA; Lopez LM; O'Brien PA; Raymond EG
[Ad] Address:Obstetrics and Gynecology, University of North Carolina, School of Medicine, CB#7570, Chapel Hill, North Carolina, USA, 27599-7570.
[Ti] Title:Progestin-only pills for contraception.
[So] Source:Cochrane Database Syst Rev;(11):CD007541, 2013 Nov 13.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The introduction of a new progestin-only oral contraceptive in Europe has renewed interest in this class of oral contraceptives. Unlike the more widely used combined oral contraceptives containing an estrogen plus progestin, these pills contain only a progestin (progestogen) and are taken without interruption. How these pills compare to others in their class or to combined oral contraceptives is not clear. OBJECTIVES: This review examined randomized controlled trials of progestin-only pills for differences in efficacy, acceptability, and continuation rates. SEARCH METHODS: Through October 2013, we searched the computerized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), POPLINE, and LILACS for studies of progestin-only pills. We also searched for current trials via ClinicalTrials.gov and ICTRP. Previous searches also included EMBASE. SELECTION CRITERIA: We included all randomized controlled trials in any language that included progestin-only pills for contraception.  We incorporated any comparison with a progestin-only pill; this could include different doses, other progestin-only pills, combined oral contraceptives, or other contraceptives. DATA COLLECTION AND ANALYSIS: The first author abstracted the data and entered the information into RevMan 5. Another author performed a second, independent data abstraction to verify the initial data entry.We attempted to extract life-table rates (actuarial or continuous) and used the rate difference as the effect measure. Where life-table rates were not published, we used the incidence rate ratio (ratio of Pearl rates). Where only the crude number of events was published, we calculated the Peto odds ratio with 95% confidence interval (CI) using a fixed-effect model. For continuous variables, the mean difference (MD) was computed with 95% CI. Because of disparate exposures, we were not able to combine studies in meta-analysis. MAIN RESULTS: Six trials met the inclusion criteria. We have not found any new studies since the initial review. In the trial comparing the desogestrel versus levonorgestrel progestin-only pill, desogestrel was not associated with a significantly lower risk of accidental pregnancy; the rate ratio was 0.27 (95% CI 0.06 to 1.19). However, the desogestrel progestin-only pill caused more bleeding problems, although this difference was not statistically significant. The trial comparing low-dose mifepristone versus a levonorgestrel progestin-only pill found similar pregnancy rates. In the trial comparing ethynodiol diacetate versus a combined oral contraceptive, irregular cycles occurred in all women assigned to the progestin-only pill (odds ratio 135.96; 95% CI 7.61 to 2421.02). In a trial comparing two progestin-only and two combined oral contraceptives, the progestin-only pill containing levonorgestrel 30 µg had higher efficacy than did the pill containing norethisterone 350 µg. An early trial found megestrol acetate inferior to other progestin-only pills in terms of efficacy. A study of the timing of pill initiation after birth found no important differences, but high losses to follow up undermined the trial. AUTHORS' CONCLUSIONS: Evidence is insufficient to compare progestin-only pills to each other or to combined oral contraceptives.
[Mh] MeSH terms primary: Contraceptives, Oral, Hormonal/administration & dosage
Progestins/administration & dosage
[Mh] MeSH terms secundary: Contraceptives, Oral, Combined/administration & dosage
Contraceptives, Oral, Hormonal/adverse effects
Desogestrel/administration & dosage
Desogestrel/adverse effects
Ethynodiol Diacetate/administration & dosage
Female
Humans
Levonorgestrel/administration & dosage
Progestins/adverse effects
Randomized Controlled Trials as Topic
Uterine Hemorrhage/chemically induced
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.; REVIEW
[Nm] Name of substance:0 (Contraceptives, Oral, Combined); 0 (Contraceptives, Oral, Hormonal); 0 (Progestins); 5W7SIA7YZW (Levonorgestrel); 62H10A1236 (Ethynodiol Diacetate); 81K9V7M3A3 (Desogestrel)
[Em] Entry month:1405
[Cu] Class update date: 160602
[Lr] Last revision date:160602
[Js] Journal subset:IM
[Da] Date of entry for processing:131115
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD007541.pub3

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[PMID]: 22928541
[Au] Autor:Polakow-Farkash S; Gilad O; Merlob P; Stahl B; Yogev Y; Klinger G
[Ad] Address:Beilinson Teratology Information Service, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
[Ti] Title:Levonorgestrel used for emergency contraception during lactation-a prospective observational cohort study on maternal and infant safety.
[So] Source:J Matern Fetal Neonatal Med;26(3):219-21, 2013 Feb.
[Is] ISSN:1476-4954
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To identify possible effects of levonorgestrel used as an emergency contraceptive during breastfeeding on mothers and their infants. STUDY DESIGN: A prospective observational cohort study of all women who contacted the Teratology Information Service between January, 2005 and January, 2010. Breastfeeding women who used levonorgestrel as an emergency contraceptive (study group) were compared to breastfeeding women who used either ethynodiol diacetate or desogestrel (control group). Women were followed for 6-24 months. Main outcome measures were adverse maternal and infant effects and continuation of breastfeeding. RESULTS: We followed 71 of 128 study group women and 72 of 100 control group women. Maternal adverse effects were mainly vaginal bleeding, which was less frequent in the study vs. control group (16 of 71 vs. 27 of 72, p = 0.068). Decreased lactation was uncommon and similar in both groups. Breastfeeding was reinitiated within less than 8 h in 75% of the levonorgestrel group women. Adverse infant effects were rare (0 of 72 infants vs. 2 of 72 infants, p = 0.5 in the study vs. control group). CONCLUSIONS: Our findings support the safety of using levonorgestrel as an emergency contraceptive during lactation without the need for withholding breastfeeding.
[Mh] MeSH terms primary: Contraception, Postcoital/adverse effects
Contraceptive Agents, Female/adverse effects
Lactation/drug effects
Levonorgestrel/adverse effects
[Mh] MeSH terms secundary: Adult
Breast Feeding/adverse effects
Case-Control Studies
Child Development/drug effects
Contraception, Postcoital/methods
Contraceptive Agents, Female/therapeutic use
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Lactation/physiology
Levonorgestrel/administration & dosage
Male
Mother-Child Relations
Patient Safety
Prospective Studies
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Contraceptive Agents, Female); 5W7SIA7YZW (Levonorgestrel)
[Em] Entry month:1307
[Cu] Class update date: 131121
[Lr] Last revision date:131121
[Js] Journal subset:IM
[Da] Date of entry for processing:120830
[St] Status:MEDLINE
[do] DOI:10.3109/14767058.2012.722730

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[PMID]: 23021311
[Au] Autor:Zafar S; Yousuf S; Kayani HA; Saifullah; Khan S; Al-Majid AM; Choudhary MI
[Ad] Address:H, E, J, Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan. saif_sahir@yahoo.com.
[Ti] Title:Biotransformation of oral contraceptive ethynodiol diacetate with microbial and plant cell cultures.
[So] Source:Chem Cent J;6(1):109, 2012 Sep 29.
[Is] ISSN:1752-153X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Biotransformation by using microbial and plant cell cultures has been applied effectively for the production of fine chemicals on large scale. Inspired by the wealth of literature available on the biotransformation of steroids, we decided to investigate the biotransformation of ethynodiol diacetate (1) by using plant and microbial cultures. RESULTS: The biotransformation of ethynodiol diacetate (1) with Cunninghamella elegans and plant cell suspension cultures of Ocimum basilicum and Azadirachta indica is being reported here for the first time. Biotransformation of 1 with Cunninghamella elegans yielded three new hydroxylated compounds, characterized as 17α-ethynylestr-4-en-3ß,17ß-diacetoxy-6α-ol (2), 17α-ethynylestr-4-en-3ß,17ß-diacetoxy-6ß-ol (3), and 17α-ethynylestr-4-en-3ß,17ß-diacetoxy-10ß-ol (4) and a known metabolite, 17α-ethynyl-17ß-acetoxyestr-4-en-3-one (5). The biotransformation of 1 with Ocimum basilicum included hydrolysis of the ester group, oxidation of alcohol into ketone, and rearrangement of the hydroxyl group. Thus four major known metabolites were characterized as 17α-ethynyl-17ß-acetoxyestr-4-en-3-one (5), 17α-ethynyl-17ß-hydroxyestr-4-en-3-one (6), 17α-ethynyl-3 ß-hydroxy-17ß-acetoxyestr-4-ene (7) and 17α-ethynyl-5α,17ß-dihydroxyestr-3-ene (8). Biotransformation of 1 with Azadirachta indica culture yielded compounds 5 and 6. Spectroscopic data of compound 8 is being reported for the first time. Structure of compound 6 was unambiguously deduced through single-crystal x-ray diffraction studies. CONCLUSION: Biotransformation of an oral contraceptive, ethynodiol diacetate (1), by using microbial and plant cell cultures provides an efficient route to the synthesis of a library of new steroids with potential contraceptive properties. These methods can be employed in the production of such compounds with high stereoselectivity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1211
[Cu] Class update date: 170220
[Lr] Last revision date:170220
[Da] Date of entry for processing:121002
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1186/1752-153X-6-109

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[PMID]: 21600824
[Au] Autor:Sherk VD; Malone SP; Bemben MG; Knehans AW; Palmer IJ; Bemben DA
[Ad] Address:Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA.
[Ti] Title:Leptin, fat mass, and bone mineral density in healthy pre- and postmenopausal women.
[So] Source:J Clin Densitom;14(3):321-5, 2011 Jul-Sep.
[Is] ISSN:1094-6950
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The purpose was to examine relationships between age, fat mass, and bone mineral density (BMD) with resting leptin levels in premenopausal and postmenopausal women. Young (aged 18-30 yr, n=30) and estrogen-deficient postmenopausal (aged 55-75 yr, n=43) women were recruited. Total body and segmental fat mass and bone-free lean body mass (BFLBM) and total body, lumbar spine, and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Serum-resting, fasted leptin levels were measured by Immunoradiometric Assay (IRMA), and leptin-to-fat mass ratios were calculated. Young and older women had similar amounts of BFLBM, but older women had greater (p<0.05) amounts of fat mass and 35% higher leptin levels. Age differences in leptin concentrations were no longer significant after controlling for fat mass. Older women had significantly (p<0.05) lower hip BMD values. Age was negatively related (r=-0.29, p<0.05) to leptin:trunk fat ratio. Increases in fat mass, not menopause per se, contributes to higher leptin levels in older women. Relationships between leptin and BMD may be age dependent.
[Mh] MeSH terms primary: Absorptiometry, Photon
Body Fat Distribution
Bone Density
Leptin/blood
Postmenopause/physiology
Premenopause/physiology
[Mh] MeSH terms secundary: Adolescent
Adult
Aged
Body Composition
Ethynodiol Diacetate
Female
Hip Joint/diagnostic imaging
Humans
Lumbar Vertebrae/diagnostic imaging
Middle Aged
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Leptin); 62H10A1236 (Ethynodiol Diacetate)
[Em] Entry month:1110
[Cu] Class update date: 161125
[Lr] Last revision date:161125
[Js] Journal subset:IM
[Da] Date of entry for processing:110524
[St] Status:MEDLINE
[do] DOI:10.1016/j.jocd.2011.03.010

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[PMID]: 21502354
[Au] Autor:Etminan M; Delaney JA; Bressler B; Brophy JM
[Ad] Address:Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC. mahyar.etminan@vch.ca
[Ti] Title:Oral contraceptives and the risk of gallbladder disease: a comparative safety study.
[So] Source:CMAJ;183(8):899-904, 2011 May 17.
[Is] ISSN:1488-2329
[Cp] Country of publication:Canada
[La] Language:eng
[Ab] Abstract:BACKGROUND: Recent concerns have been raised about the risk of gallbladder disease associated with the use of drospirenone, a fourth-generation progestin used in oral contraceptives. We conducted a study to determine the magnitude of this risk compared with other formulations of oral contraceptives. METHODS: We conducted a retrospective cohort study using the IMS LifeLink Health Plan Claims Database. We included women who were using an oral contraceptive containing ethinyl estradiol combined with a progestin during 1997-2009. To be eligible, women had to have been taking the oral contraceptive continuously for at least six months. We computed adjusted rate ratios (RRs) for gallbladder disease using a Cox proportional hazards model. In the primary analysis, gallbladder disease was defined as cholecystectomy; in a secondary analysis, it was defined as hospital admission secondary to gallbladder disease. RESULTS: We included 2,721,014 women in the cohort, 27,087 of whom underwent surgical or laparoscopic cholecystectomy during the follow-up period. Compared with levonorgestrel, an older second-generation progestin, a small, statistically significant increase in the risk of gallbladder disease was associated with desogestrel (adjusted RR 1.05, 95% confidence interval [CI] 1.01-1.09), drospirenone (adjusted RR 1.20, 95% CI 1.16-1.26) and norethindrone (adjusted RR 1.10, 95% CI 1.06-1.14). No statistically significant increase in risk was associated with the other formulations of oral contraceptive (ethynodiol diacetate, norgestrel and norgestimate). INTERPRETATION: In a large cohort of women using oral contraceptives, we found a small, statistically significant increase in the risk of gallbladder disease associated with desogestrel, drospirenone and norethindrone compared with levonorgestrel. However, the small effect sizes compounded with the possibility of residual biases in this observational study make it unlikely that these differences are clinically significant.
[Mh] MeSH terms primary: Androstenes/adverse effects
Contraceptives, Oral, Hormonal/adverse effects
Gallbladder Diseases/chemically induced
[Mh] MeSH terms secundary: Adult
Cholecystectomy/statistics & numerical data
Confidence Intervals
Contraceptives, Oral, Combined/adverse effects
Contraceptives, Oral, Synthetic/adverse effects
Desogestrel/adverse effects
Ethinyl Estradiol/administration & dosage
Ethinyl Estradiol/adverse effects
Female
Humans
Levonorgestrel/adverse effects
Progestins/administration & dosage
Progestins/adverse effects
Proportional Hazards Models
Retrospective Studies
Risk
Risk Factors
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Name of substance:0 (Androstenes); 0 (Contraceptives, Oral, Combined); 0 (Contraceptives, Oral, Hormonal); 0 (Contraceptives, Oral, Synthetic); 0 (Progestins); 423D2T571U (Ethinyl Estradiol); 5W7SIA7YZW (Levonorgestrel); 81K9V7M3A3 (Desogestrel); N295J34A25 (drospirenone)
[Em] Entry month:1107
[Cu] Class update date: 150204
[Lr] Last revision date:150204
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:110420
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.110161

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[PMID]: 20659389
[Au] Autor:Melvin L
[Ti] Title:Contraceptive failure and the progestogen-only pill.
[So] Source:J Fam Plann Reprod Health Care;36(3):182, 2010 Jul.
[Is] ISSN:1471-1893
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: Contraceptives, Oral, Synthetic
Ethynodiol Diacetate
Obesity
Progestins
[Mh] MeSH terms secundary: Adult
Body Mass Index
Body Weight
Female
Humans
Medication Adherence
Treatment Failure
[Pt] Publication type:COMMENT; LETTER
[Nm] Name of substance:0 (Contraceptives, Oral, Synthetic); 0 (Progestins); 62H10A1236 (Ethynodiol Diacetate)
[Em] Entry month:1010
[Cu] Class update date: 161020
[Lr] Last revision date:161020
[Js] Journal subset:IM
[Da] Date of entry for processing:100728
[St] Status:MEDLINE
[do] DOI:10.1783/147118910791749362

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[PMID]: 20659371
[Au] Autor:Chandler J; Nash K
[Ad] Address:Central Family Planning Clinic, Grove Road, Norwich NR1 3RH, UK. julia.chandler@nnuh.nhs.uk
[Ti] Title:Contraceptive failure and the progestogen-only pill: the issue of body weight.
[So] Source:J Fam Plann Reprod Health Care;36(3):167-8, 2010 Jul.
[Is] ISSN:1471-1893
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: Contraceptives, Oral, Synthetic
Ethynodiol Diacetate
Obesity
Pregnancy, Unwanted
Progestins
[Mh] MeSH terms secundary: Abortion, Induced
Adult
Body Mass Index
Body Weight/physiology
Female
Humans
Medication Adherence
Pregnancy
Treatment Failure
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Contraceptives, Oral, Synthetic); 0 (Progestins); 62H10A1236 (Ethynodiol Diacetate)
[Em] Entry month:1010
[Cu] Class update date: 161020
[Lr] Last revision date:161020
[Js] Journal subset:IM
[Da] Date of entry for processing:100728
[St] Status:MEDLINE
[do] DOI:10.1783/147118910791749191

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[PMID]: 20091638
[Au] Autor:Grimes DA; Lopez LM; O'Brien PA; Raymond EG
[Ad] Address:Behavioral and Biomedical Research, Family Health International, PO Box 13950, Research Triangle Park, North Carolina, USA, NC 27709.
[Ti] Title:Progestin-only pills for contraception.
[So] Source:Cochrane Database Syst Rev;(1):CD007541, 2010 Jan 20.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The introduction of a new progestin-only oral contraceptive in Europe has renewed interest in this class of oral contraceptives. Unlike the more widely used combined oral contraceptives containing an estrogen plus progestin, these pills contain only a progestin (progestogen) and are taken without interruption. How these pills compare to others in their class or to combined oral contraceptives is not clear. OBJECTIVES: This review examined randomized controlled trials of progestin-only pills for differences in efficacy, acceptability, and continuation rates. SEARCH STRATEGY: We searched the computerized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), POPLINE, LILACS, and EMBASE for studies of progestin-only pills. We also searched for current trials via ClinicalTrials.gov and ICTRP. SELECTION CRITERIA: We included all randomized controlled trials in any language that included progestin-only pills for contraception. We incorporated any comparison with a progestin-only pill; this could include different doses, other progestin-only pills, combined oral contraceptives, or other contraceptives. DATA COLLECTION AND ANALYSIS: The first author abstracted the data and entered the information into RevMan 5. Another author performed a second, independent data abstraction to verify the initial data entry. Because of disparate exposures, we were not able to combine studies in meta-analysis. MAIN RESULTS: Six trials met the inclusion criteria. In the trial comparing the desogestrel versus levonorgestrel progestin-only pill, desogestrel was not associated with a significantly lower risk of accidental pregnancy; the rate ratio was 0.27 (95% CI 0.06 to 1.19). However, the desogestrel progestin-only pill caused more bleeding problems, although this difference was not statistically significant. The trial comparing low-dose mifepristone versus a levonorgestrel progestin-only pill found similar pregnancy rates. In the trial comparing ethynodiol diacetate versus a combined oral contraceptive, irregular cycles occurred in all women assigned to the progestin-only pill (odds ratio 135.96; 95% CI 7.61 to 2421.02). In a trial comparing two progestin-only and two combined oral contraceptives, the progestin-only pill containing levonorgestrel 30 mug had higher efficacy than did the pill containing norethisterone 350 mug. An early trial found megestrol acetate inferior to other progestin-only pills in terms of efficacy. A study of the timing of pill initiation after birth found no important differences, but high losses to follow up undermined the trial. AUTHORS' CONCLUSIONS: Evidence is insufficient to compare progestin-only pills to each other or to combined oral contraceptives.
[Mh] MeSH terms primary: Contraceptives, Oral, Hormonal/administration & dosage
Progestins/administration & dosage
[Mh] MeSH terms secundary: Contraceptives, Oral, Combined/administration & dosage
Contraceptives, Oral, Hormonal/adverse effects
Desogestrel/administration & dosage
Desogestrel/adverse effects
Ethynodiol Diacetate/administration & dosage
Female
Humans
Levonorgestrel/administration & dosage
Progestins/adverse effects
Randomized Controlled Trials as Topic
Uterine Hemorrhage/chemically induced
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Name of substance:0 (Contraceptives, Oral, Combined); 0 (Contraceptives, Oral, Hormonal); 0 (Progestins); 5W7SIA7YZW (Levonorgestrel); 62H10A1236 (Ethynodiol Diacetate); 81K9V7M3A3 (Desogestrel)
[Em] Entry month:1004
[Cu] Class update date: 140521
[Lr] Last revision date:140521
[Js] Journal subset:IM
[Da] Date of entry for processing:100122
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD007541.pub2


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