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  • Title: [Parenteral contraceptive drugs: depot progestins].
    Author: Rabe T, Runnebaum B.
    Journal: Wien Med Wochenschr; 1987 Nov 15; 137(20-21):474-9. PubMed ID: 2967589.
    Abstract:
    Depot progestins as injectables, implantables or vaginal rings are suitable for contraception in those female patients, in which risk factors (e.g. cardiovascular risk) exclude the use of estrogen-progestin mixtures. In this paper the mode of action, indications, contraindications, advantages and disadvantages of the various methods using depot-progestins are discussed. Injectables contain either medroxyprogesterone acetate or norethistronenantate; both steroids are released slowly within a limited time interval (2 to 4 months) out of a depot. The major effect is a change of the cervical mucus. Side-effects are disturbances of the menstrual cycle (e.g. breakthrough bleedings) as well as an amenorrhea after frequent use (up to 50% of all cases). The subdermal implantables (Norplant 2 or 5) release levonorgestrel out of a depot over a time period of at least 5 years. Steroid plasma levels are lower than in those patients using a progestin-only pill. Side-effects of implantables are disturbances of the menstrual cycle (e.g. breakthrough bleeding); in patients who desire to conceive a child or suffer from undesirable side-effects the implantables can be removed at every time. The progestin releasing vaginal rings are in a stage of controlled clinical trials. The advantages depend on ethe easy mode of administration (implantation or removal). Side-effects are also breakthrough bleedings. Depot progestins as injectables, implants, or vaginal rings are suitable for contraception in those females for whom risk factors such as cardiovascular risk exclude the use of estrogen-progestin mixtures. The mode of action, indications, contraindications, advantages, and disadvantages of the various methods using depot progestins are discussed. Injectables contain either medroxyprogesterone acetate or norethisterone enanthate; both steroids are released slowly over a finite time interval (2-4 months). The major effect is a change in cervical mucus. Side effects include disturbances in the menstrual cycle (e.g., breakthrough bleeding) as well as amenorrhea after frequent use (up to 50% of all cases). The subdermal implants (Norplant 2 or 5) release levonorgestrel out of a depot over a period of at least 5 years. Steroid plasma levels are lower than in those patients using a progestin-only pill. Side effects of implants include disturbances of the menstrual cycle as above. In patients who desire to conceive or suffer from undesirable side effects, the implants can be removed at any time. The progestin-releasing vaginal rings are in a stage of controlled clinical trials. The advantages depend on the easy mode of administration (implant or removal). Side effects also include breakthrough bleeding. (author's modified)
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