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Skip to main content. Log In Sign Up. Current status of inyeftables hormonal contraception, with special reference to the monthly method.

Advances in Contraception, ; Printed in the Netherlands Current status of injectable hormonal contraception, with special reference to the trikestrales method M. LEON 3R. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal.

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Main motivation factors are: Introduction Contraception is a universal and trimdstrales right of human beings, as an integral part of the right to health. Healthcare professionals have an obligation to keep themselves updated about all aspects of contraception, as well as to contribute technical support to the community through various media.

Every health service supplying contraceptive methods should provide a counseling service for facilitating decision-making. This document is the result of the consensus achieved in two working meetings by health professionals from Central America and the Caribbean.

It does not imply commitment by the trimestralds countries. The document provides a technical guide to those persons who carry out contra- ceptive provision at a public or private level. Bimonthly and quarterly injectables The largest experiment with progestogen-only injectables has utilized two products: The subsequent injections are applied according to calendar, regardless of the pattern of the menstrual periods of each user.

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After six months of treatment, Noristerat can be applied every 84 days [2]. Studies in experimental animals showing histopathological changes such as pituitary hyperplasia, mammary nodules and malignant tumors, endometrial carcinoma, etc.

Pathological changes have been found in studies of all progestogens, even of progesterone, when these are used in experimental animals at high doses and for prolonged periods [5].

Therefore, there is consensus that the obstacle related to the long-term safety has been overcome [8]. In general, these disturbances do not threaten the patient’s health. Indeed, noted specialists cite the advantage that amenorrhea the most frequent alteration may represent in deprived populations with a tendency to sideropenic anemia [12]. Although appropriate counseling is correlated with better continuance rates [14], many women appear to consider the regularity of their menses as a sign of good health and reproductive integrity, demand that it be preserved, and stop using a method that disturbs it.

Therefore at the population level, this is a true drawback of progestogen-only injectable contraceptives. According to WHO studies, half or more of women stop using DepoProvera and Noristerat within one year, complaining mainly of irregular menses [4].

Depression, hair loss etc. Resumption of fertility has been delayed eight months or more after the last injection of DepoProvera, regardless of its prolonged use, so these injectables do not inyectabled appropriate for women planning to become pregnant within the next year. Caution and supervision are recommended in women with abnormal liver function, history or evidence of cardiovascular disease, diabetes mellitus or a history of gestational diabetes, hyperlipidemias, or who are older than 40 years.

Actually, this is observed not only when estrogens and progestogens are administered by the parenteral route, but also when such combined hormonal contraception is applied by the oral or vaginal routes. The higher number of trjmestrales, which in some circumstances may be considered an inconvenience, is balanced in practice by a greater regularity of menstrual cycles.


This brings about a greater adherence of the user to the method, which is important in any family-planning program.

According to WHO [19], at present about two million women use this method. There are several formulations of once-a-month injectable contraceptives. Others are being tested, and at present there are three formulations which have provided greater experience: Cyclofem and Mesigyna have been developed recently, and after international multicenter trials they have entered the registration, distribution and marketing stages in various countries [18]. Also, the greatest similarity to the natural progesterone is that of DHPA, which virtually lacks other actions androgenic, for example [21].

In this regard, the intermediate position is that of MPA, which has a scant androgenic action [23]. The estrogens mentioned are derivatives of the natural 17b-estradiol. At the endometrial level it promotes an initial proliferation that progestogens alone cannot produce, and correlates with a menstrual rhythm more like the physiologic one [25].

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Dosage Regarding dosage schedules [18], Topasel can be injected intramuscularly, preferably on the 8th day of the cycle, but at any time between the 7th and the 10th days. A usually practical recommendation for instructing the users in this respect is to tell them that if their menstruation starts on Monday they should receive the injection preferably the next Monday, or from one day before to two days later.

There is no information available about the advantages or disadvantages of this schedule compared to that for Topasel. The Pearl Index for Topasel, based on the study of women treated through cycles, is from 0. That for Cyclofem, based on 41 cycles in women, is 0.

In a later article including studies with Cyclofem on users at various centers, the annual pregnancy rates reported were between 0 and 0.

Current Status of Injectable Hormonal Contraception Pharmacologic surveillance The fact that Topasel has been available for a longer time and contains a higher estrogen dose than the other two products brought about extensive pharmacologic surveillance studies at both the experimental and the clinicotherapeutic level. An assay in Mexico [35] found an increase of serum estrone in women who had been receiving Topasel for an average time of 6.

However, one month later and after another injection, their estrone levels were normal. So far, the longest studies reported with Cyclofem and Mesigyna are of 2 and 3 years, respectively [18,29].

Naturally, up to now there has been virtually no opportunity for carrying out postmarketing surveillance studies. An investigation carried out in Mexico and Chile [50] did not reveal any correlation between the use of this product and cervical cancer. Among the numerous clinical studies with Topasel, the incidence of menstrual irregularities varies between 2. Nevertheless, menstrual disturbances are among the most frequent complaints leading to stopping of monthly injectable method [18].

There have also been reports of prolonged cycles, hyper- and hypomenorrhea, spotting, dripping, and intermenstrual hemorrhages. Withdrawals from treatment because of amenorrhea vary between 0. As usual, disturbances of the menstrual pattern are better tolerated by those women who were forewarned about it and who know that such disturbances do not threaten their health, and who have a good rapport with their physician or family planning service.

Therefore, previous good counseling is important. However, digestive manifestations nausea, vomiting are less frequent with parenteral administration. Treatment dis- continuations for these reasons may occur but are uncommon. Return of fertility As with combined oral contraceptives, ovulation and fertility come back after discontinuation of treatment.


In some cases these may be delayed, usually not more than 90 days. Post-treatment ovulation and normal pregnancies have been ascertained in reports regarding Topasel, Cyclofem and Mesigyna [18]. Decreases in the quantity and quality of the protein, lipid and electrolyte content of milk have been reported [53].

There is also a report about the use of Topasel in ten women who continued breastfeeding, nine of whom did not notice any change in the quantity of milk or in the health of their babies [57].

There are no data available about Mesigyna or Cyclofem in these circumstances. For the time being, the postpartum use of monthly injectable contraceptives should be started after weaning. Further studies are recommended [18]. According to the lastest data about Cyclofem, dis- continuation rates within one year have ranged from Usually, the women are young, of medium or low sociocultural and economic levels, and living on the outskirts of big cities or in rural areas.

In practice, however, the indications, contraindications and precautions are the same for the monthly injectables as for the combined oral contraceptives.

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Considering this, the injectable method is a valid option for any woman who cannot, does not know how, or simply does not want to depend on the daily intake of tablets. Precautions, warnings and contraindications Monthly injectable contraceptives are a form of combined hormonal therapy. Consequently, as occurs with the oral methods, they should be prescribed and used under medical control. Basically, the same indications, contraindications, precautions and warnings apply to both of them [18].

Caution is recommended in women who smoke, especially if they are older than 35 years of age, and in those with a history of diabetes mellitus or gestational diabetes, cardiovascular disease, thromboembolic disease or hypertension, chronic gallbladder or hepatic disease, coagulation disorders, abnormal cervical cytology requiring further study, or possible elective surgery.

Although there are no reports about drug interactions, it is worthwhile to record and monitor clinically the concomitant use of rifampicin, barbiturates or hydantoins. Until further antlconceptivos is available, postpartum use is recommended only after weaning.

Conclusions and summary Injectable contraceptives are a valid option in every family planning program. They stand out because of their prolonged action and because they do not have the contraindications of the estrogens.

Even though this has not been proved to be a health hazard, many users abandon treatment for this reason. This correlates with a greater acceptability and higher rates of adherence to treatment by the users. Long-term safety problems have not been observed with the monthly injectables either. In this regard, the largest study has been that with Iyectables. Sixty years of znticonceptivos contraception: Regulation of Human Fertility.

Multinational comparative clinical trial of long-acting injectable contraceptives: Current Status of Injectable Hormonal Contraception 5. Adv Steroid Biochem Pharmacol. Facts about injectable contraceptives. Bull World Health Org. Injectable contraception with depot medroxyprogesterone acetate. Contraception with a single implant releasing the synthetic progestin ST DMPA and breast cancer: Schachter M, Sholam Z. New developments in oral, injectable and implantable contraceptives, vaginal rings and intrauterine devices.

Anticonceptivos inyectables de dosis mensual. Facts about once-a-month injectable contraceptives: