contraceptives--postcoital and Amenorrhea

Topics: Amenorrhea; Biological Assay; Carbohydrate Metabolism; Contraceptive Agents; Contraceptives, Oral; Contraceptives, Postcoital; Estrogens; Eye Diseases; Female; Gonadotropins; Humans; Hypertension; Lipoproteins; Liver; Nandrolone; Neoplasms; Ovulation; Progesterone; Skin Manifestations; Testosterone; Thromboembolism; Transcortin

RU 486 is the first antiprogesterone to be used clinically. It inhibits the action of the hormone at the receptor level in target tissues. Its action is particularly significant in the endometrium where it prevents the initiation and progression of pregnancy in the first weeks (contragestive effects). The data indicate that the compound can be used for: voluntary interruption of pregnancy between 6 and 10 weeks, induction of menstruation during the fifth week of amenorrhea, and post-coital contraception. Current trials include its use as a once-a-month menses inducer. It can also be utilized for therapeutic interruption at a late stage of pregnancy, and tried as adjuvant treatment in some case of breast cases. The data on RU 486 have been obtained through studies in physio-pharmacological endocrinology and biochemistry. The development of this antihormone represents a concerted research effort between biology and medicine.. RU 486 steroid, the 1st antiprogesterone which may be used in human therapy, prevents the hormone action by taking its place at the receptor level in target cells. It is a norethindrone derivative of the historical progestagen of oral contraception. Its affinity for the progesterone receptor is high, it is orally active, and toxicology studies fail to show any other effects than the endocrine consequences which may be expected from an antihormone. Consequently, it can be tested as a "contragestive" agent, putting emphasis on the fact that a few hours interruption of the progesterone action prevents pregnancy. At the Department of Obstetrics and Gynecology at the Geneva Hospital Cantonal, women who had asked to terminate 6-10 week pregnancies were administered 200 mg RU 486 to be taken orally for 4 days. The present results concern several hundred pregnancy terminations. With RU 486 alone, a unique dose of less than 400-600 mg, given in the evening, was more efficient than 50-200 mg/day for 3-7 days as in the initial trials. The results were particularly satisfactory when the compound was administered within the days following the assumed date of menstruation (5th week of amenorrhea). Several cases of normal pregnancies have been reported after using RU 486, including 1 as early as the following month. The analysis of the RU 486 mechanism of action showed that the blockage of the progesterone activity on decidualized endometrium causes the detachment of the embryo, resulting in a drop in hCG and secondary luteolysis. Then, prostaglandins are produced, as in laboratory animals, thus increasing contractility of the uterine muscles, such property already being used in pregnancy interruption. Thus, the fact of adding on the 4th day of the RU 486 treatment a weak dosage of synthetic prostaglandin equal to 1/6 of that used alone when inducing abortions made a clear improvement in the results possible. Trials have shown the feasibility of using RU 486 as a means of postcoital contraception. The monthly use of RU 486, at each cycle, of RU 486 as a menses-inducer for women who have regular coitus, is still under study. A study as to how much and for how long RU 486 is to be prescribed should make it possible to define conditions for maintaining a regular menstrual cycle. Conversely, other trials may lead to the use of RU 486 to monitor or suppress ovulation. RU 486 also makes it possible to provoke the therapeutic abortion of dead or abnormal fetuse

Topics: Abortifacient Agents; Abortifacient Agents, Steroidal; Abortion, Spontaneous; Amenorrhea; Contraceptives, Postcoital; Estrenes; Female; Humans; Mifepristone; Models, Biological; Pregnancy

The authors discuss the menstrual pattern during lactation, which lengthens the birth interval primarily by extending the period of postpartum amenorrhea. The length of postpartum amenorrhea varies greatly as it is influenced by such factors as breastfeeding practices (duration and extent of supplementry feeding); maternal constitution factors (e.g., maternal age and nutritional status); and pregnancy wastage and infant survival. Since full lactation prevents menstruation for a longer period of time than does partial lactation, supplementary feeding of suckling infants influences the return of menstruation. Also, increase in age and parity is frequently associated with longer periods of postpartum amenorrhea. It is difficult to determine if ovulation occurs during the 1st menstrual cycle after delivery or if it occurs regularly during subsequent menstrual cycles. It is assumed that the 1st 1 or 2 menstrual cycles following delivery are anovulatory, apparently in the cycle before menstruation. Thus about 1/2 of all nonlactating women are fertile before the 1st postpartum menstrual period. Ovulation is likely to precede menstruation in fully lactating women, but the longer menstruation is delayed by lactatioon, the more likely that the ust cycle will be ovulatory. The occurance of ovulation after return of menstruation is significantly higher than ovulation before the return of menstruation until 9th postpartum month during lactation. The incidence of pregnancy in fully lactating mothers is 1.3% by the 3rd postpartum month, increasing to 26% at the 12th postpartum month. The incidence of pregnancy before and after return of menstruation is significantly high. This is due to the high rate of ovulation after return of menstruation. When pregnancy rate in ovulating lactating mothers before and after return of menstruation is compared, no significant difference is detected. Also discussed are the ovulation inhibiting effects of progestational drugs (medroxyprogesterone acetate) used as a contraceptive during the postpartum period, as well as those of the nonhormonal drug, sulpiride, on the menstrual pattern during lactation. The authors' discussion refers to the results of other studies in the field.

Topics: Amenorrhea; Breast Feeding; Contraception; Contraceptives, Postcoital; Demography; Disease; Family Planning Services; Health; Hormones; Infant Mortality; Infant Nutritional Physiological Phenomena; Injections; Lactation; Maternal Age; Medroxyprogesterone Acetate; Menstrual Cycle; Menstruation; Nutritional Physiological Phenomena; Ovulation; Ovulation Detection; Parity; Population; Population Dynamics; Postpartum Period; Pregnancy; Puerperal Disorders; Reproduction; Time Factors

Topics: Abortion, Legal; Amenorrhea; Contraception; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Drug Combinations; Female; Humans; Male; Thrombosis

Topics: Adolescent; Adult; Amenorrhea; Biopsy; Body Weight; Contraceptives, Oral; Contraceptives, Postcoital; Demography; Endometrium; Female; Humans; Lactation; Menstruation; Norgestrel; Norpregnadienes; Pregnancy; Progestins; Uterine Hemorrhage; Vaginal Smears

Topics: Adolescent; Adult; Amenorrhea; Cervix Uteri; Contraceptives, Oral; Contraceptives, Postcoital; Endometrium; Female; Humans; Lactation; Menstruation; Norpregnadienes; Pregnancy; Progestins