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  • Title: The vaginal contraceptive pill.
    Author: Coutinho EM.
    Journal: Adv Contracept Deliv Syst; 1986 Feb; 2(1):30-6. PubMed ID: 12267727.
    Abstract:
    The results of clinical trials of vaginal contraceptive pills suggest that this is a safe, effective, and acceptable means of fertility control. Plasma levels of progesterone rise at a slower pace and to a lower peak value when contraception is administered vaginally rather than orally. Despite lower blood levels, ovulation is suppressed in the majority of cycles and fertility control compares favorably with that observed in users of low-dose combined OCs. Lower steroid blood levels and the fact that vaginal pills bypass the liver minimize the occurrence of side effects noted in some OC users such as nausea, gastric intolerance, headaches, weight gain, and dizziness. In 1 clinical trial, 124 women used a vaginal pill containing 500 mcg of d-1-norgestrel and 50 mcg of ethinyl estradiol for 6-20 months, for a total of 1438 women-months. No pregnancies occurred in this series. Bleeding generally developed 3-5 days after insertion of the last pill and lasted 3-5 days in 98% of cycles. The interval between withdrawal bleeding events was 26-30 days in 86% of cycles. Breakthrough bleeding occurred in only 6 subjects. Vaginal discharge, involving pathogenic agents similar to those found in OC users, developed in 26 (20%) of subjects. 44 women (36%) discontinued before 1 year of use: 7 cited medical reasons (mastalgia, vaginal irritation), 6 desired pregnancy, and the remaining 31 found daily insertion tedious or distasteful. No significant changes occurred in blood cell counts, hematocrit, or blood chemistry. Smaller clinical trials of both Gestrinone, an anti-estrogenic progesterone, and a vaginal pill containing 50 mcg of mestranol and 1 mg of norethindrone have obtained similar results. These findings suggest that the vaginal contraceptive pill may offer family planning clinics a better alternative than OCs as the 1st prescribed contraceptive.
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