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  • Title: The effect of small doses of progesterone released from two types of vaginal rings on ovarian activity and bleeding patterns during the first postpartum year.
    Author: Landgren BM, Jonsson B, Cekan SZ.
    Journal: Contraception; 1995 Apr; 51(4):255-60. PubMed ID: 7796592.
    Abstract:
    A total of 20 breastfeeding women used progesterone-releasing vaginal rings for up to 12 months. The women were divided into two groups, one (n = 9) using rings with an initial release rate of 5 mg/24 h, the other (n = 11) with a release rate of 20 mg/24 h. Individual women started to give breast milk supplements and ceased to breastfeed after various periods of time. Urinary estrone and pregnanediol glucuronide levels were measured by radioimmunoassay three times weekly during the entire trial. Individual diary cards were used to register bleeding and spotting. A significantly higher concentration of pregnanediol glucuronide was seen when the 20 mg/24 h ring was used in the lactation period, in comparison with the 5 mg/24 h ring. In the post-lactation period, pregnanediol glucuronide levels dropped when the 20 mg/24 h ring was used. Estrone glucuronide levels increased after the termination of breastfeeding, indicating an enhanced suppression of ovarian activity in the lactation period with both rings. Although the degree of suppression was dose-related, both rings were likely to offer a sufficient contraceptive effect in the lactation period. No significant changes were observed when milk supplements were added to breastfeeding. The use of the 20 mg/24 h ring resulted in a much better bleeding pattern (significantly less bleeding days) than the 5 mg/24 h ring during the lactation period. In the post-lactation period, the 20 mg/24 h ring the bleeding because much worse than in the lactation period.(ABSTRACT TRUNCATED AT 250 WORDS) In Sweden, 23 lactating women 6-8 weeks postpartum accepted a vaginal ring that initially releases either 5 mg or 20 mg progesterone/day. Researchers followed 20 women for 1 year and examined the urinary glucuronides and the metabolites of estradiol and progesterone, estrone and pregnanediol, to observe changes in ovarian activity. They also documented bleeding patterns. Women using the 20 mg/24 hour ring had a lower bleeding rate during the lactation period than the postlactation period (6.1 vs. 23.6 days; p 0.01). Bleeding rates dropped somewhat among women using the 5 mg/24 hour ring, but did not differ significantly between these two periods (22.7 vs. 20.2 days). Estrone glucuronide levels rose significantly in both groups after lactation ceased (5 mg/24 hour ring: 44.8 vs. 101.8 nmol/l, p 0.05; 20 mg/24 hour ring: 22.5 vs. 42.4 nmol/l, p 0.01), suggesting increased suppression of ovarian activity during lactation. The 5 mg/24 hour ring induced higher estrone glucuronide levels both during and after lactation than the 20 mg/24 hour ring (44.8 vs. 22.5 nmol/l and 101.8 vs. 42.4 nmol/l, respectively; p 0.01), indicating a dose-related degree of ovarian activity suppression. For both vaginal rings there were no differences in the degree of ovarian suppression between the full breast feeding period and the breast feeding with supplementation period. Pregnanediol glucuronide levels were much higher in users of the 20 mg/24 hour ring during lactation than after lactation (9.2 vs. 6.1; p 0.01). The increase in pregnanediol glucuronide levels in users of the 5 mg/24 hour ring after lactation had ceased was not significant (4.6 vs. 6.6 nmol/l). During lactation, users of the 20 mg/24 hour ring had higher levels than users of the 5 mg/24 hour ring (4.6 vs. 9.2 nmol/l; p 0.05), while, during the postlactation period, the levels were similar (6.6 vs. 6.1 nmol/l). In conclusion, the 20 mg/24 hour ring is preferable during lactation, and if users are concerned about bleeding after lactation ends, they can switch to another contraceptive.
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