Long-term follow-up of women treated with contraceptive implants of levonorgestrel Norplant

This report describe the long-term follow-up of 376 women who received Norplant implants in the period october 1974 through may 1979. One-hundred-and-ten subjects received replacement implants after variable lengths of use of the first set. The average levonorgestrel plasma levels declined steadily through eight years of use of Norplant capsules (r = -937). Values were 0.35 ng/ml, 0.29 ng/ml and 0.22 ng/ml at treatment years 1, 5 and 8, respectively. Levonorgestrel plasma levels after replacement with a second set of implants were similar to those observed after the first insertion, either when placed in the same site as the first set or in a different area. The levonorgestrel half-life after implant removal was 42 +/- 16 h (X +/- S.E.) and only trace amounts are detected after 96 h. Nineteen pregnancies occurred during 18,530 woman-months of use of the first set of implants, eleven of them during years 6 through 8 of treatment. The Pearl Index for the first years of Norplant implants use was 0.63. No pregnancy has occurred in 5.020 woman-months observed during treatment with a second set of capsules. Fifty-six women (14.9%) out of 376 acceptors of the first implant and 12 (10.9%) out of 110 acceptors of the replacement implants were terminated for other medical reasons, mainly side effects commonly associated with hormonal contraception. Removals for bleeding problems occurred in 5.6% and 3.6% of the acceptors of the first and second implant, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Problems with condoms -- a population-based study among Finnish men and women.

OBJECTIVE: This study evaluates men's and women's opinions of condom use and problems with it in real life. METHODS: Random samples of men and women, aged 18-50 years, were drawn from the Finnish Population Register and were mailed a questionnaire on family planning. Response rates were 36% for men (706) and 58% for women (1136). Respondents were asked e.g. about condom use, whether they had had problems with it and why they used condoms. Moreover they were asked if they had received advice on how to use condoms. RESULTS: Among both men and women 87% had at some time used condoms. Of all men 37% and of women 34% reported that they had at some time had a failure with condom use; among both men and women one in four had experienced condom breakage. The use of condoms with the main purpose of preventing sexually transmitted diseases was somewhat low. The proportion of respondents having received advice on condom use was greater among younger men and women. CONCLUSION: A patient with problems in condom use is not uncommon in consultations in primary health care, and thus personnel working there hold a key position in promoting condom use. The role of school health care should be assured to offer basic sexual and reproductive counselling to every generation.     

Norplant and other implantable contraceptives

Implantable contraception represents a safe, reversible form of long-term family planning with distinct advantages. It does not contain estrogen, thus avoiding many of it contraindications. Importantly, it is extremely effective, has high continuation rates, and is well tolerated. The main side effects of Norplant are irregular menstrual bleeding and the occasional difficult removal. Although recent high-profile litigation has severely diminished enthusiasm for Norplant, the FDA has reaffirmed its safety and efficacy. Norplant remains a viable family planning option for carefully selected women. New contraceptive implants may soon be available accentuating the advantages of Norplant while minimizing the disadvantages.     

Cytoplasmic estrogen receptor concentrations in the endometrium of Finnish and Japanese women

Cytoplasmic estrogen receptor concentrations in the endometrium were determined in 13 Finnish and 20 Japanese women. All the women were premenopausal and aged between 40 and 50. The concentration of estrogen receptors in the proliferative endometrium for Finnish women was 246.9 +/- 46.2 fmol/mg protein (mean +/- S.E.M.) and that for Japanese women 45.7 +/- 17.1 fmol/mg protein. The difference is significant (P less than 0.01). In the secretory endometrium the corresponding figures were 97.8 +/- 33.7 fmol/mg protein for Finnish and 20.0 +/- 6.4 fmol/mg protein for Japanese women (P less than 0.05). During the proliferative phase the serum estrone concentration was significantly higher in Finnish than in Japanese women (P less than 0.05).     

长期使用Norplant皮下埋植剂对子宫内膜超微结构影响的研究

目的　探讨Norplant皮下埋植剂长期使用对子宫内膜超微结构的影响。 方法　 1989年 10月至 2 0 0 2年 6月中山大学附属二院对 2 99例使用Norplant埋植剂达 5年以上的妇女 ,观察其子宫内膜的形态学 (光镜与电镜 )变化。结果　长期使用组月经表现较为正常 ,妊娠率为 0 33/10 0妇女年。宫腔镜直视下见子宫内膜变薄 ,77 0 8%子宫内膜覆盖良好 ;光镜下子宫内膜腺体数量减少 ,分布不均匀 ,部分呈萎缩型改变 ,间质蜕膜样改变 ,疏松 ,轻度水肿 ;电镜下腺上皮细胞呈低柱状 ,胞体变小 ,微绒毛脱落 ,稀疏 ,分泌颗粒减少 ,线粒体肿胀 ,外膜消失 ,基质变淡 ,甚至呈空泡状 ,粗面内质网扩张 ,此外 ,间质细胞出现细胞凋亡。结论　长期使用Norplant皮下埋植剂可抑制子宫内膜的发育 ,对子宫内膜是安全的。     

Endothelial nitric oxide synthase polymorphism is not associated with placental abruption in Finnish women

OBJECTIVE: To study whether genetic variability in the gene encoding endothelial nitric oxide synthase (eNOS) affects individual susceptibility to the development of placental abruption during pregnancy. METHODS: One hundred and sixteen pregnant women with placental abruption and 113 healthy controls were genotyped for Glu298Asp polymorphism in the eNOS gene. Chi-square analysis was used to assess the differences in genotype and allele frequencies between the two groups. RESULTS: A statistically similar allelic distribution of eNOS Glu298Asp polymorphism was observed in the two groups, with the frequency of the variant G allele being 66.8% in the abruption group and 68.1% in the control group (OR 0.94, 95% CI: 0.64-1.39; p = 0.76). The genotype distribution of the eNOS polymorphism was also found to be statistically similar (p = 0.72). CONCLUSIONS: The observed genotype data in subjects from eastern Finland suggest that the Glu298Asp polymorphism of the eNOS gene does not contribute to placental abruption in this population.     

Norplant皮下埋植剂长期使用的有效性临床研究—八年经验

上海医科大学妇产科医院于１９８４年１０月至１９９３年１２月应用Ｎｏｒｐｌａｎｔ皮下埋植剂１６５７例（其中Ｎｏｒｐｌａｎｔ—Ⅰ型１３５６例，Ｎｏｒｐｌａｎｔ－Ⅱ３０１例）控制生育。１、３、５、６、７、８年的累积妊娠率分别为０、０．１、０．９、１．７、２．６、和３．３／１００妇女；妊娠率与最初埋植时的体重有关，体重重者妊娠率高。持续使用率分别为９７．１、８２．２、７３．５、４４．７、３４．３和１８．５／１００妇女。主要副反应为月经失调，是终止使用的主要原因；但总失血量不多，随着使用时间的延长，月经失调副反应逐渐减少。埋植剂的放置和取出技术易于掌握，在１６５７例使用中，未发生感染或其他并发症，使用安全。由于其妊娠率低，和不可能脱落及其高度可逆性，深为受术者欢迎。     

Education and Counseling for Norplant Users

Because Norplant provides effective contraception for 5 years, it is an excellent choice for many women. However, it has side effects that have prompted early removal in a significant number of women. Nurses who educate and counsel women about Norplant before insertion and provide support and management of side effects afterward can increase user satisfaction and long-term continuation.     

Administration of an antiprogesterone up-regulates estrogen receptors in the endometrium of women using Norplant: a pilot study

OBJECTIVE: To determine the effect of a single dose of mifepristone (200 mg) on endometrial estrogen and progesterone receptors in Norplant users. DESIGN: A prospective single-blind placebo-controlled pilot study. SETTING; Women were recruited from a large family planning clinic and were studied either at the clinic or in a clinical research unit attached to a teaching hospital gynecology department. PATIENT(S): Eight women using Norplant and experiencing vaginal bleeding more often than once every 24 days. All completed the study. INTERVENTION(S): Endometrial biopsies were taken after treatment with both placebo and 200 mg of mifepristone, both given at the start of a bleeding episode. MAIN OUTCOME MEASURE(S): Expression of endometrial progesterone (PR) and estrogen (ER) receptors, ovulation, and vaginal bleeding. RESULT(S): Mifepristone administration was associated with down-regulation of PR receptor subtype B and up-regulation of ER. Women treated with mifepristone showed a tendency to increased ovulation rates and reduced vaginal bleeding. CONCLUSION(S): The effect of mifepristone on endometrial steroid receptors was consistent with functional inhibition of progesterone. The findings warrant further investigation of this regimen as a strategy to reduce frequent bleeding.     

Multidrug resistance 3 gene mutation 1712delT and estrogen receptor alpha gene polymorphisms in Finnish women with obstetric cholestasis

Vulvar vestibulitis syndrome, which represents one of the major cause of dyspareunia, is a puzzling clinical entity. Although many treatment options have been employed, a rationale therapeutic strategy is still not stated. The present article reviews the most popular medical approaches of such entity (biofeedback, tricyclic antidepressants, interferon psychologic-behavioural therapy, diet modification), as well as those to avoid.Tricyclic antidepressants and biofeedback of the pelvic floor muscles represents the first line effective therapy. Moreover, psychological counselling must support any treatment options.     

Multidrug resistance 3 gene mutation 1712delT and estrogen receptor alpha gene polymorphisms in Finnish women with obstetric cholestasis

OBJECTIVE: To investigate the contribution of the estrogen receptor alpha (ERalpha) polymorphism in the development of obstetric cholestasis and to determine whether multidrug resistance 3 (MDR3) gene 1712delT mutation detected in French patients is also present in Finnish women with obstetric cholestasis. STUDY DESIGN: In a retrospective case-control study, two ERalpha polymorphisms and MDR3 gene mutation 1712delT were investigated in healthy control women (N=47) and in women with diagnosis of obstetric cholestasis (N=57). PvuII and XbaI polymorphisms in ERalpha gene were evaluated in genomic DNA by using the polymerase chain reaction (PCR). In addition, the frequencies in the general population in our area are presented for comparison. RESULTS: None of the ERalpha genotypes or alleles was significantly over-represented in obstetric cholestasis. When the two ERalpha gene polymorphisms were analyzed in parallel, six genotype combinations were recognized, and the distribution of these genotype combinations did not reveal statistically significant differences between the cases and controls (P=0.612). No patient or control was heterozygous or homozygous for the mutant allele in the MDR3 gene. CONCLUSION: The present data indicate that polymorphism of the ERalpha and MDR3 genes 1712delT mutation are unlikely to play any significant role in obstetric cholestasis in affected Finnish women. Further work to identify explanatory factors is of particular interest.     

Norplant: reasons for discontinuation and side-effects.

OBJECTIVE: To study the side-effects and reasons for the discontinuation of Norplant. METHODS: The study was based on the analysis of the medical records of 265 Norplant users, who obtained Norplant from two clinics of the Family Planning Association of Pakistan and who were followed for 5 years. RESULTS: The most common reason (29.4%) for the discontinuation of Norplant was menstrual disturbances, followed by medical problems (4.1%), desire for more children (3.1%) and family problems (3.1%). The major side-effects were weight gain, breast tenderness, headache and dizziness. Only 7.7% of users mentioned any change in sexual behavior and 69.6% of the complaints leading to Norplant removal developed within 6 months of insertion. CONCLUSION: The extent and nature of the side-effects experienced by Pakistani women using Norplant are similar and comparable to those reported from other countries.