norethindrone-enanthate and Uterine-Hemorrhage

To determine the effect of postnatal administration of the long-acting progestogen contraceptive, norethisterone enanthate, on postnatal depression and on serum hormone concentrations, and their association with depression.. Double-blind randomised placebo-controlled trial.. A tertiary care hospital in Johannesburg, South Africa. POPULATION Postnatal women using a non-hormonal method of contraception (n = 180).. Random allocation within 48 hours of delivery to norethisterone enanthate by injection, or placebo.. Depression scores in the three months postpartum as rated by the Montgomery-Asberg Depression Rating Scale (MADRS) and the Edinburgh Postnatal Depression Scale (EPDS); 2. serum 17beta-oestradiol, progesterone, testosterone and the 17beta-oestradiol:progesterone ratio at six weeks postpartum.. There was a chance excess of caesarean section deliveries in the progestogen group. Mean depression scores were significantly higher in the progestogen group than in the placebo group at six weeks postpartum (mean MADRS score 8.3 vs 4.9; P = 0.0111; mean EPDS score 10.6 vs 7.5; P = 0.0022). Mean serum 17beta-oestradiol and progesterone concentrations were significantly lower in the progestogen group compared with the placebo group at six weeks postpartum. There were no correlations between any of the hormone parameters and depression at six weeks except in the formula feeding subgroup of the placebo group, where formula feeding and 17beta-oestradiol concentrations were positively associated with depression.. Long-acting norethisterone enanthate given within 48 hours of delivery is associated with an increased risk of developing postnatal depression and causes suppression of endogenous ovarian hormone secretion.

Topics: Adult; Contraceptives, Oral, Synthetic; Depression, Postpartum; Double-Blind Method; Estradiol; Female; Humans; Norethindrone; Postnatal Care; Pregnancy; Progesterone; Prognosis; Risk Factors; Testosterone; Uterine Hemorrhage

Norethisterone enanthate (NET-EN) 50 mg combined with estradiol valerate (EV) 5 mg was studied as a once-a-month injectable contraceptive with regard to effectiveness, cycle control, adverse events and acceptability. In eight Family Planning Centres from five Latin American countries, 931 fertile women were followed-up for a period of 36 months, providing a total of 15,787 woman-months of experience. Only one pregnancy occurred: in the first treated month a few days before the second injection (failure rate 0.08 per 100 woman-years). Under treatment, the first cycle was drastically shortened in most cases, but thereafter cycles tended to recover to pre-treatment patterns. There was a significant decrease of hypermenorrhoea and dysmenorrheic cycles. Intracyclic bleeding and spotting appeared in 1.8% and 2.2%, respectively, and amenorrhea in 2.8% of cycles. The incidence of other adverse events was very low with the exception of weight gain of more than 2 kg (36.8%). The continuation rate at 12 months was 64.7%, at 24 months 31.0% and at 36 months 20.4%. The cumulative discontinuation rate due to bleeding problems was 6.1% and 7.2% due to adverse events at 36 months. The treatment was shown to be a highly effective contraceptive method that offers fairly good cycle control, good tolerance and a continuation rate that makes it suitable for use in family planning programmes in the Latin American area.

Topics: Amenorrhea; Body Weight; Contraceptive Agents, Female; Estradiol; Female; Humans; Injections; Latin America; Norethindrone; Pregnancy; Uterine Hemorrhage

349 women were given Depo-Provera and 304 were given Nur-Isterate immediately after delivery. No significant difference in duration or amount of bleeding was found between the two injectables over 6 months. Although the incidence and duration of bleeding were greater when injectables were used postpartum than when used electively, they were not excessive. This option should therefore not be withheld. Treatment with anti-inflammatory and anti-fibrinolytic agents were not effective in controlling bleeding.

Topics: Contraceptive Agents, Female; Double-Blind Method; Female; Humans; Injections; Medroxyprogesterone; Medroxyprogesterone Acetate; Naproxen; Norethindrone; Postpartum Period; Pregnancy; Tranexamic Acid; Uterine Hemorrhage

Long-acting progestin contraceptives have been available in many countries for a number of years with a large number of women now using them. Although some improvements in delivery systems have been made, the major problem with progestin-only contraceptives remains unpredictable endometrial breakthrough bleeding (BTB), which is responsible for more than 50% of drop-outs from this form of contraception. Using hysteroscopy, endometrial petechiae and ecchymoses are a common finding among Norplant users, although these features do not always correlate with BTB. It has been postulated that epithelial and subepithelial tissues may provide a barrier to BTB, as long as epithelial integrity is maintained. The aim of this pilot study is to explore structural changes in the endometrial surface epithelium, and subepithelial collagen III fibres. Endometrial biopsies from noresthisterone-enanthate (NetEn) users (n = 6) and controls (n = 6) were assessed using routine haematoxylin and eosin staining and immunohistochemical staining for cytokeratins 8, 18 and 19, and collagen III. A conventional silver impregnation method was also used to identify subepithelial collagen III fibres. Most of the Net-En tissues showed reduced surface epithelial cell height compared controls (P = 0.002). Cytokeratin staining as weaker (P = 0.04) and distributed evenly between basal and apical parts of the cell in Net-En tissue, compared to more apically in controls. Both immunohistochemical and conventional silver staining methods revealed that the subepithelial collagen III meshwork remained unchanged in Net-En compared to control endometrium. Both staining methods identified collagen fibres with equal sensitivity. In conclusion, atrophic changes remain the dominant appearance for progestin-exposed endometrium, with reduced cytokeratin staining, but apparently there is little change in subepithelial collagen III expression.

Topics: Adult; Biopsy; Collagen; Contraceptive Agents, Female; Endometrium; Epithelium; Female; Humans; Hysteroscopy; Immunohistochemistry; Keratins; Norethindrone; Progesterone Congeners; Silver Staining; Staining and Labeling; Uterine Hemorrhage

This review of progress in the area of injectable contraception focuses on the pharmacokinetics, mode of action, use-effectiveness, bleeding problems, and metabolic effects of medroxyprogesterone acetate, norethisterone enanthate, and monthly injectables. The advantages of injectable contraception include greater efficacy than either oral contraception or IUDs, less heavy bleeding, no need to remember pills, and no effect on lactation. Irregular bleeding constitutes the major drawback of this method. If adequate counseling is provided before the injections are started, discontinuation rates due to irregular bleeding can be reduced. Initial delay in return of fertility is less with norethisterone enanthate than medroxyprogesterone acetate. The issue of the carcinogenicity of both drugs is considered resolved, and there are no clinical effects of altered lipids. This suggests that both these compounds should be freely available as safe, effective contraceptives. Monthly injectable preparations are highly effective as well, and should give better cycle control than longacting regimens. There are inadequate data from which to draw conclusions regarding the return of fertility or metabolic effects and carcinogenesis. These preparations pose logistic and financial problems for national family plannig programs and require users to make more frequent clinic visits. Assessment of the role of monthly injectables should be postponed until further studies have been completed.

Topics: Adult; Cervix Mucus; Contraceptive Agents, Female; Endometrium; Female; Humans; Injections, Intramuscular; Kinetics; Lactation; Lipid Metabolism; Medroxyprogesterone; Medroxyprogesterone Acetate; Norethindrone; Pregnancy; Uterine Hemorrhage