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Tiffany Note on sale in the United States

Family physicians provide contraceptive counseling to a significant number of patients each year. Knowledge of the wide variety of contraceptive methods and barriers to the use of some of these methods is important in helping each patient make an appropriate choice.Traditional Methods of ContraceptionThe benefits, side effects, and potential complications of traditional methods of contraception are reviewed in detail elsewhere.6-8 A summary of these methods is provided in Table 1.8-11It is important to note certain changes that have occurred in the past several years. For example, no contraceptive sponges currently are Tiffany Note on sale in the United States, although a new vaginal sponge (Protectaid) is under investigation. Likewise, the levonorgestrel implant system marketed as Norplant is no longer being manufactured; however, a single-rod implant (Implanon), presently used outside the United States, may become available in the future.

A combination OCP that contains the new progestogen drospirenone (Yasmin) has been available for several years. Drospirenone has some antimineralocorticoid activity and has been shown to decrease the water retention, negative affect, and appetite changes that commonly are associated with menstrual cycle changes.12 [Strength of Recommendation (SOR) B, descriptive studies and lower quality clinical trials] Serum potassium levels should be monitored when women use this OCP in conjunction with other medicines that also raise potassium levels, because hyperkalemia is a potential side effect.

Finally, studies on the length of time that active pills are given Tiffany Pendant on sale provided more options and flexibility for OCP users.13 The U.S. Food and Drug Administration (FDA) recently approved the use of levonorgestrel-ethinyl estradiol (Seasonale) in an extended OCP regimen consisting of 84 days of active pills and seven days of nonhormonal pills.Newer Methods of ContraceptionTraditional methods of contraception have some drawbacks (Table 1).8-11 Consequently, patient dissatisfaction and inconsistent or incorrect use may result in unintended pregnancy. For example, the success of OCPs, the most widely used reversible contraceptive method, is highly dependent on daily adherence. In one study,14 approximately 47 percent of OCP users failed to take one or more pills per cycle, and 22 percent failed to take two or more pills.In designing the newer contraceptives, attention has been given to improving the side effect profiles of older methods and to developing delivery systems that do not require daily patient adherence.VAGINAL CONTRACEPTIVE RING

The combined hormonal vaginal ring (NuvaRing) has a Tiffany Ring on sale delivery system. The ring works in a similar manner as OCPs, but daily action by the patient is not required. The ring (Figure 1), which releases ethinyl estradiol at a rate of 15 mcg per day and etonogestrel at a rate of 120 mcg per day, is placed in the vagina for three weeks. If for some reason the ring is out of the vagina for more than three hours, back-up contraception should be used until the ring has been back in place for seven days. After three weeks, the ring is removed for one week, and a new ring is inserted. Withdrawal bleeding occurs during the ring-free week.In a one-year study,15 the overall Tiffany Watch on sale rate for the vaginal ring was 0.65 pregnancies per 100 women-years. The majority of women in the study considered insertion and removal of the vaginal ring to be easy, and 90 percent used the device correctly. Adverse effects that led to discontinuation of vaginal ring use most often were related to foreign body sensation, coital problems, and expulsion of the device. However, only 3.6 percent of women in the study stopped using the device for these reasons.

The combined hormonal injection, which contains 25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate, is another method of contraception that does not require daily adherence. Unlike progestinonly preparations, this injection is given monthly. The combined hormonal injection is available outside the United States. Although approved by the FDA, the combined hormonal injection currently is not being manufactured in this country, and its tiffanys availability is unknown.Clinical trials have shown this contraceptive method to be highly effective, with life-table failure rates of zero to 0.2 pregnancies per 100 women-years.17 Because of the added estrogen, bleeding patterns usually are regular and comparable with the bleeding patterns occurring with combination OCPs.18In 2002, the FDA approved the use of a combination contraceptive patch (Ortho Evra) that releases 20 mcg of ethinyl estradiol and 150 mcg of norelgestromin per day. It inhibits ovulation in much the same way as OCPs. The patch is applied weekly for three weeks, followed by a patch-free week during which withdrawal bleeding occurs. Recommended application sites include the upper arm, buttocks, lower abdomen, and upper torso (excluding the breasts).



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