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Contraception. 2006 Feb; 73(2):195-204.The use of progestogen-only contraceptives among women with sickle cell anemia has generated concerns about possible hematological and other clinical complications. Based on the literature, we assessed whether use of progestogen-only contraceptives is associated with adverse health effects among women with sickle cell anemia. We searched the MEDLINE database for articles published in peer-reviewed journals between 1966 and September 2004 that were relevant to sickle cell anemia and use of progestogen-only contraceptives. Of the 70 articles identified through the search, 8 met the criteria for this review. These studies did not identify any adverse events or clinically or statistically significant adverse changes in hematological or biochemical parameters associated with the use of progestogen-only contraceptive methods. Six studies suggested that users experienced a decrease in clinical symptoms and less frequent and severe painful crises compared with nonusers. Although data are limited, these studies suggest that progestogen-only contraceptives are safe for women with sickle cell anemia. (author's)
ENTRE NOUS. 1991 Dec; (19):15.About 8 million women use the long acting injectable contraceptive depot-medroxy-progesterone acetate (DMPA) and norethisterone enanthate (NET-EN). These progesterone only injectables are not dependent on sexual activity and are easy to administer. Yet they are not always well accepted since they can interfere with menstrual bleeding and often induce amenorrhea. Researchers find that adding estrogen to DMPA and NET-EN treats these irregularities. They must use esters with limited action to protect the endometrium from constant estrogens, however, which requires monthly injections. Thus bleeding occurs once a month just like the normal menstrual cycle. Clinical trials in China of Injectable No. 1 (250 mg 17-alpha-hydroxyprogesterone caproate and 5 mg estradiol valerate) show that it has few side effects and is acceptable. Other trials in China are evaluating monthly injectables with NET-EN or megestrol acetate. Numerous developing countries often as WHO's Special Programme of Research in Human Reproduction for effective, safe, and fully studied monthly injectables. WHO operates under a 2 part strategy: optimum improvement of HPR 102 (50 m NET-EN and 5 mg estradiol valerate) and Cyclofem (25 mg DMPA and 5 mg estradiol cypionate) resulting in a reduction of the dose of at least 1 of the hormones and results of a study of the efficacy and side effects of these 2 injectables. It hopes the study provides the impetus to introduce them into national family planning programs. It demonstrates that they are indeed efficacious, effect fewer changes in the menstrual cycle than the progesterone only injectables, and are well accepted, even though women must go to a clinic every 27-33 days for an injection. Other studies are determining their effects on lipid and glucose metabolism, coagulation, and fibrinolysis. They are also looking at the time needed for ovulation to return. 1 study shows that menstruation returned in all women by the 3rd cycle.
IPPF MEDICAL BULLETIN. 1987 Apr; 21(2):1-2.Within the past 25 years, steroidal preparations have become available that allow the user contraceptive protection over extended periods of time. There are only 2 injectable preparations presently used at all widely within family planning programs throughout the world: 1) depot medroxyprogesterone acetate (DMPA), and 2) norethisterone enanthate (NET-EN). 1 of the major side effects of progestagen-only contraception has been disruption of normal menstrual bleeding, giving rise to both irregular bleeding and amenorrhea. Several extensive reports on the clinical use of monthly injectables appeared in 1970, but few studies have been reported subsequently. In response to the demand from certain populations to have safe, well-investigated, once-a-month injectable contraceptives with high efficacy and little menstrual bleeding disturbance, the World Health Organization's (WHO) Special Programme of Research in Human Reproduction developed a strategy for the development of a once-a-month contraceptive which involves: 1) the assessment of use-effectiveness and side-effects of HRP102 (NET-EN, 50 mg., plus oestradiol valerate, 5 mg) and Clyloprovera (DMPA, 25 mg., plus estradiol cypionate, 5 mg.); and 2) the optimum improvement of these 2 combined formulas by reduction of the progestagen content. Results from a pharmacokinetic/pharmacodynamic study show that many of the women receiving reduced progestagen dose preparations ovulated during the 3rd treatment month; thus the 2 original preparations, Cycloprovera and HRP102 appear to be the optimal formulations for these combinations of steroids. Plans are being developed to make 1 or both of these available for introduction into certain family planning programs in developing countries early in 1988.