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Elsimar Metzker Coutinho - One of the best experts on this subject based on the ideXlab platform.
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effects of a single silastic contraceptive Implant containing nomegestrol acetate uniplant on endometrial morphology and ovarian function for 1 year
Contraception, 2006Co-Authors: I C Barbosa, Elsimar Metzker Coutinho, Renata Lopes, Hugo Maia, Antonio Carlos Vieira Lopes, Cristina Fernandes Noronha, Adelmo BottoAbstract:Purpose: This study was undertaken to evaluate the effects of a Subdermal Implant containing nomegestrol acetate (Uniplant) on endometrial histology and ovarian function. Methods: Twenty healthy female volunteers of reproductive age were included and completed a menstrual diary throughout the study. Hysteroscopy, transvaginal sonography and blood sampling were performed prior to Implant insertion (control cycle) and following 6 and 12 months of Uniplant use. Transvaginal sonography was performed every other day from Day 8 of the cycle up to the obtainment of sonographic evidence of a 12-mm follicle, then every day until the obtainment of sonographic evidence of follicular rupture and thereafter every other day until the next menstrual bleeding. Blood samples were taken for the measurement of estradiol, follicle-stimulating hormone, luteinizing hormone and progesterone on the same days on which transvaginal sonography was performed. The Implants were removed after 1 year. Results: Twenty percent of cycles were ovulatory, and 80% were anovulatory. The development of persistent nonluteinized follicle occurred in 40% of all cycles studied, inadequate luteal phase occurred in 20% of cycles and no follicular development occurred in 40%. Endometrial thickness remained below 8 mm in all cycles studied. Alterations in endometrial vascularization were observed in all treated cycles. Conclusion: Our results suggest that this long-acting contraceptive method affects follicular growth and endometrial vascularization, disrupts endometrial architecture and leads to inadequate luteal phase.
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carbohydrate metabolism in sickle cell patients using a Subdermal Implant containing nomegestrol acetate uniplant
Contraception, 2001Co-Authors: Ione Cristina Barbosa, O A Ladipo, Nascimento Maria P De Lourdes, Celia Athayde, Cristina Hirsch, Renata Lopes, Bruno Matias, Elsimar Metzker CoutinhoAbstract:Uniplant, a second-generation contraceptive Implant, has been demonstrated to promote a significant improvement in the overall well-being of women with sickle cell anemia. It has been suggested that the discrete increase in blood glucose levels observed in Uniplant users could be a contributory factor for clinical improvement. Ten healthy sickle cell patients were enrolled in the study. An oral glucose tolerance test was performed prior to Implant insertion and at 1, 6, and 12 months of therapy. Blood glucose and insulin were measured before and at 30, 60, 120, and 180 min after a 75-g glucose load. The glucose and insulin areas under the curves were calculated. Fasting glycosylated hemoglobin was also measured. No significant changes were observed in glycosylated hemoglobin, glucose or insulin. We conclude that Uniplant is a safe contraceptive for sickle cell patients.
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original research article carbohydrate metabolism in sickle cell patients using a Subdermal Implant containing nomegestrol acetate uniplant
2001Co-Authors: Ione Cristina Barbosa, O A Ladipo, Cristina Hirsch, Renata Lopes, Bruno Matias, Maria De Lourdes, Paulo Do Nascimento, Elsimar Metzker CoutinhoAbstract:Uniplant, a second-generation contraceptive Implant, has been demonstrated to promote a significant improvement in the overall well-being of women with sickle cell anemia. It has been suggested that the discrete increase in blood glucose levels observed in Uniplant users could be a contributory factor for clinical improvement. Ten healthy sickle cell patients were enrolled in the study. An oral glucose tolerance test was performed prior to Implant insertion and at 1, 6, and 12 months of therapy. Blood glucose and insulin were measured before and at 30, 60, 120, and 180 min after a 75-g glucose load. The glucose and insulin areas under the curves were calculated. Fasting glycosylated hemoglobin was also measured. No significant changes were observed in glycosylated hemoglobin, glucose or insulin. We conclude that Uniplant is a safe contraceptive for sickle cell patients. © 2001 Elsevier Science Inc. All rights reserved.
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neuroendocrine mechanism of anovulation in users of contraceptive Subdermal Implant of nomegestrol acetate uniplant
Fertility and Sterility, 1997Co-Authors: Kurt T Barnhart, Luigi Devoto, Ricardo Pommer, Teresa Sirpettermann, Jorge Robinovic, Elsimar Metzker CoutinhoAbstract:Objective To evaluate a nomegestrol acetate Subdermal contraceptive Implant's (Uniplant; Thermex, Monaco) effect on the hypothalamus-pituitary-ovarian axis. Design A prospective clinical trial. Setting San Borja-Arriaran Clinical Hospital, University of Chile, School of Medicine. Patient(s) Normally cycling healthy women. Intervention(s) Insertion of Uniplant. Main Outcome Measure(s) Luteinizing hormone pulse and endocrine profiles were assessed before, 48 hours after insertion, and after prolonged use of the Implant. Result(s) Anovulation was noted in 100% of users in the first month. Seventy percent of subjects demonstrated follicular development with the absence of ovulation and an endocrine profile similar to the follicular phase: (LH pulse/8 hours 6.85 ± 0.67, LH amplitude 3.54 ± 0.65 mlU/mL (conversion factor to SI unit, 1.00), and E 2 193 ± 29.4 pg/mL (conversion factor to SI unit, 3.67), whereas 30% demonstrated no follicular activity with an endocrine profile similar to the luteal phase: (LH pulse/8 hours; 3.66 ± 0.66, LH amplitude 5.76 ± 1.73 mlU/mL, and E 2 67.5 ± 4 pg/mL. Clinical characteristics, serum gonadotropin concentration, and LH pulse characteristics failed to predict which subjects would initiate or remain devoid of follicular activity. Conclusion(s) Uniplant results in anovulation via two mechanisms: hypothalamic suppression in subjects who lack follicular development, and likely suppression of the pituitary LH surge in subjects who initiate follicular activity. Fertil Steril ® 1997;67:250-5
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changes in the menstrual bleeding of users of a Subdermal contraceptive Implant of nomegestrol acetate uniplant do not influence sexual frequency sexual desire or sexual enjoyment
Fertility and Sterility, 1997Co-Authors: Kurt T Barnhart, Elsimar Metzker Coutinho, Ricardo Pommer, Irene Furman, Luigi DevotoAbstract:Objective To evaluate the effect of menstrual changes induced by a nomegestrol acetate Subdermal contraceptive Implant (Uniplant; Thermex, Bahia, Brazil) on users' sexuality. Design Prospective observational survey. Setting San Borja-Arriaran Hospital, University of Chile, School of Medicine. Patient(s) Normally cycling healthy women and their partners. Intervention(s) Structured interview before and during use of the contraceptive. Main Outcomes Measure(s) Sexual frequency, desire, and enjoyment; perception of health; and contraceptive satisfaction. Result(s) During the use of the Implant more women reported irregular cycles (32% versus 11%) and vaginal spotting (38% versus 19%). Frequency of sexual relations was unchanged (2.3 versus 2.5/wk) but the percent of couples engaging in sexual relations during vaginal spotting increased (28% versus 11%). There was no significant difference in the percent of men or women who reported an increase, or decrease, in perceived sexual desire, sexual enjoyment, or perception of heath during the use of Uniplant. Conclusion(s) Despite the alterations in menstrual cyclicity and the occurrence of spotting, the use of a contraceptive Subdermal Implant of nomegestrol acetate did not effect desire for, enjoyment of, or frequency of sexual relations in users. Fertil Steril ® 1997; 67:244-9
Jeffrey F Peipert - One of the best experts on this subject based on the ideXlab platform.
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Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project.
Obstetrics and gynecology, 2017Co-Authors: Abigail Iseyemi, Qiuhong Zhao, Colleen Mcnicholas, Jeffrey F PeipertAbstract:Objective To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy. Methods We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or Subdermal Implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy. Results Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37-4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68-2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5-2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1-1.7). Conclusion Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy.
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preventing unintended pregnancy the contraceptive choice project in review
Journal of Womens Health, 2015Co-Authors: Natalia E Birgisson, Tessa Madden, Gina M Secura, Qiuhong Zhao, Jeffrey F PeipertAbstract:Abstract The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14–45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2–3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% Subdermal Implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-...
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use of the etonogestrel releasing contraceptive Implant
Expert Review of Obstetrics & Gynecology, 2013Co-Authors: Jaclyn M Grentzer, Colleen Mcnicholas, Jeffrey F PeipertAbstract:The single-rod, etonogestrel-releasing, Subdermal Implant (ENG Implant) is the most effective, long-acting reversible method of contraception available. The failure rate of the ENG Implant is 0.05%, which makes it more effective than female sterilization. It is discreet, easy to insert and remove, has no effect on future fertility and is associated with a number of noncontraceptive health benefits. The ENG Implant is safe and effective when used in the postpartum and postabortion setting, and in women who have contraindications to estrogen. The most common reason cited for discontinuation is irregular and unpredictable bleeding. However, structured, preinsertion counseling can increase continuation and user satisfaction.
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the contraceptive choice project reducing barriers to long acting reversible contraception
American Journal of Obstetrics and Gynecology, 2010Co-Authors: Gina M Secura, Jenifer E Allsworth, Tessa Madden, Jennifer L Mullersman, Jeffrey F PeipertAbstract:Objective To introduce and promote the use of long-acting reversible methods of contraception (LARC; intrauterine contraceptives and Subdermal Implant) by removing financial and knowledge barriers. Study Design The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women 14-45 years who want to avoid pregnancy for at least 1 year and are initiating a new form of reversible contraception. Women screened for this study are read a script regarding long-acting reversible methods of contraception to increase awareness of these options. Participants choose their contraceptive method that is provided at no cost. We report the contraceptive choice and baseline characteristics of the first 2500 women enrolled August 2007 through December 2008. Results Sixty-seven percent of women enrolled (95% confidence interval, 65.3–69.0) chose long-acting methods. Fifty-six percent selected intrauterine contraception and 11% selected the Subdermal Implant. Conclusion Once financial barriers were removed and long-acting reversible methods of contraception were introduced to all potential participants as a first-line contraceptive option, two-thirds chose long-acting reversible methods of contraception.
O A Ladipo - One of the best experts on this subject based on the ideXlab platform.
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carbohydrate metabolism in sickle cell patients using a Subdermal Implant containing nomegestrol acetate uniplant
Contraception, 2001Co-Authors: Ione Cristina Barbosa, O A Ladipo, Nascimento Maria P De Lourdes, Celia Athayde, Cristina Hirsch, Renata Lopes, Bruno Matias, Elsimar Metzker CoutinhoAbstract:Uniplant, a second-generation contraceptive Implant, has been demonstrated to promote a significant improvement in the overall well-being of women with sickle cell anemia. It has been suggested that the discrete increase in blood glucose levels observed in Uniplant users could be a contributory factor for clinical improvement. Ten healthy sickle cell patients were enrolled in the study. An oral glucose tolerance test was performed prior to Implant insertion and at 1, 6, and 12 months of therapy. Blood glucose and insulin were measured before and at 30, 60, 120, and 180 min after a 75-g glucose load. The glucose and insulin areas under the curves were calculated. Fasting glycosylated hemoglobin was also measured. No significant changes were observed in glycosylated hemoglobin, glucose or insulin. We conclude that Uniplant is a safe contraceptive for sickle cell patients.
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original research article carbohydrate metabolism in sickle cell patients using a Subdermal Implant containing nomegestrol acetate uniplant
2001Co-Authors: Ione Cristina Barbosa, O A Ladipo, Cristina Hirsch, Renata Lopes, Bruno Matias, Maria De Lourdes, Paulo Do Nascimento, Elsimar Metzker CoutinhoAbstract:Uniplant, a second-generation contraceptive Implant, has been demonstrated to promote a significant improvement in the overall well-being of women with sickle cell anemia. It has been suggested that the discrete increase in blood glucose levels observed in Uniplant users could be a contributory factor for clinical improvement. Ten healthy sickle cell patients were enrolled in the study. An oral glucose tolerance test was performed prior to Implant insertion and at 1, 6, and 12 months of therapy. Blood glucose and insulin were measured before and at 30, 60, 120, and 180 min after a 75-g glucose load. The glucose and insulin areas under the curves were calculated. Fasting glycosylated hemoglobin was also measured. No significant changes were observed in glycosylated hemoglobin, glucose or insulin. We conclude that Uniplant is a safe contraceptive for sickle cell patients. © 2001 Elsevier Science Inc. All rights reserved.
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the effects of nomegestrol acetate Subdermal Implant uniplant on serum cholesterol triglycerides and lipoproteins in nigerian users
Contraception, 2000Co-Authors: A O Adekunle, Abiodun F Fakokunde, A O Arowojolu, O A LadipoAbstract:Abstract The study was conducted to assess the effects of a nomegestrol acetate Subdermal contraceptive Implant (Uniplant®) on the lipid profiles of indigenous Nigerian women. Cholesterol content of the major lipoproteins, along with total cholesterol and triglycerides, were measured in fasting blood samples collected before Implant insertion and then at months 1, 3, 6, and 12 of use. All volunteers were of the reproductive age, healthy, and had no contraindications to hormonal contraception. The mean levels of cholesterol and low density lipoprotein-cholesterol (LDL-C) increased gradually, albeit insignificantly, from insertion to month 12 of Implant use. An initial decline in the mean levels of high density lipoprotein-cholesterol (HDL-C), reaching a minimal level (37.31 ± 4.95 mg/dl) at month 3 of Implant use, was observed. This was followed by a gradual rise that peaked (39.73 ± 5.53 mg/dL) at month 12. These values were, however, not significantly different from the preinsertion value. The only significant difference (p
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the effects of nomegestrol acetate Subdermal Implant uniplant on carbohydrate metabolism serum lipoproteins and on hepatic function in women
Contraception, 1995Co-Authors: Ione Cristina Barbosa, Elsimar Metzker Coutinho, O A Ladipo, Celia Athayde, Sven Eric Olsson, Ulf UlmstenAbstract:Abstract This study was undertaken to assess possible variations in body weight, blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, SGPT, SGOT, GGT and bilirubin in women bearing a single Subdermal Silastic Implant containing 55 mg (10%) of nomegestrol acetate during two years. A total of eighteen volunteers of reproductive age who desired to avoid conception were enrolled in this study. Subjects were healthy women with no contraindications to hormonal contraception. All women were investigated before starting treatment and were followed up for one year. At the end of one year the capsules were removed and a new capsule was inserted. Fasting blood samples were drawn at 8:00 to 8:30 am twice prior to Implant insertion and then at the first, third, sixth and twelfth months and every six months thereafter. Body weight increased from 54.9 ± 1.5 kg at admission to 55.3 ± 2.0 kg at 12 months of use (p A slight increase in both systolic and diastolic blood pressure was recorded at month 12 (p Insulin, HbA1C, LDL-C and GGT remained unchanged during twenty-four months of Uniplant use. A significant decrease in total cholesterol (p These results demonstrated that, within the normal range, variation of fasting glucose is not correlated with changes in insulin levels. The minor changes in serum lipoproteins, SGOT, SGPT and bilirubin were transient. Since no marked and consistent changes were observed and since all levels were within the normal range, it is concluded that no clinical effects on lipoproteins, carbohydrate metabolism, insulin levels and on hepatic function were observed in women using Uniplant for two years.
Luigi Devoto - One of the best experts on this subject based on the ideXlab platform.
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neuroendocrine mechanism of anovulation in users of contraceptive Subdermal Implant of nomegestrol acetate uniplant
Fertility and Sterility, 1997Co-Authors: Kurt T Barnhart, Luigi Devoto, Ricardo Pommer, Teresa Sirpettermann, Jorge Robinovic, Elsimar Metzker CoutinhoAbstract:Objective To evaluate a nomegestrol acetate Subdermal contraceptive Implant's (Uniplant; Thermex, Monaco) effect on the hypothalamus-pituitary-ovarian axis. Design A prospective clinical trial. Setting San Borja-Arriaran Clinical Hospital, University of Chile, School of Medicine. Patient(s) Normally cycling healthy women. Intervention(s) Insertion of Uniplant. Main Outcome Measure(s) Luteinizing hormone pulse and endocrine profiles were assessed before, 48 hours after insertion, and after prolonged use of the Implant. Result(s) Anovulation was noted in 100% of users in the first month. Seventy percent of subjects demonstrated follicular development with the absence of ovulation and an endocrine profile similar to the follicular phase: (LH pulse/8 hours 6.85 ± 0.67, LH amplitude 3.54 ± 0.65 mlU/mL (conversion factor to SI unit, 1.00), and E 2 193 ± 29.4 pg/mL (conversion factor to SI unit, 3.67), whereas 30% demonstrated no follicular activity with an endocrine profile similar to the luteal phase: (LH pulse/8 hours; 3.66 ± 0.66, LH amplitude 5.76 ± 1.73 mlU/mL, and E 2 67.5 ± 4 pg/mL. Clinical characteristics, serum gonadotropin concentration, and LH pulse characteristics failed to predict which subjects would initiate or remain devoid of follicular activity. Conclusion(s) Uniplant results in anovulation via two mechanisms: hypothalamic suppression in subjects who lack follicular development, and likely suppression of the pituitary LH surge in subjects who initiate follicular activity. Fertil Steril ® 1997;67:250-5
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changes in the menstrual bleeding of users of a Subdermal contraceptive Implant of nomegestrol acetate uniplant do not influence sexual frequency sexual desire or sexual enjoyment
Fertility and Sterility, 1997Co-Authors: Kurt T Barnhart, Elsimar Metzker Coutinho, Ricardo Pommer, Irene Furman, Luigi DevotoAbstract:Objective To evaluate the effect of menstrual changes induced by a nomegestrol acetate Subdermal contraceptive Implant (Uniplant; Thermex, Bahia, Brazil) on users' sexuality. Design Prospective observational survey. Setting San Borja-Arriaran Hospital, University of Chile, School of Medicine. Patient(s) Normally cycling healthy women and their partners. Intervention(s) Structured interview before and during use of the contraceptive. Main Outcomes Measure(s) Sexual frequency, desire, and enjoyment; perception of health; and contraceptive satisfaction. Result(s) During the use of the Implant more women reported irregular cycles (32% versus 11%) and vaginal spotting (38% versus 19%). Frequency of sexual relations was unchanged (2.3 versus 2.5/wk) but the percent of couples engaging in sexual relations during vaginal spotting increased (28% versus 11%). There was no significant difference in the percent of men or women who reported an increase, or decrease, in perceived sexual desire, sexual enjoyment, or perception of heath during the use of Uniplant. Conclusion(s) Despite the alterations in menstrual cyclicity and the occurrence of spotting, the use of a contraceptive Subdermal Implant of nomegestrol acetate did not effect desire for, enjoyment of, or frequency of sexual relations in users. Fertil Steril ® 1997; 67:244-9
LARC Guideline Dev Grp - One of the best experts on this subject based on the ideXlab platform.
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The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline
HUMAN REPRODUCTION, 2008Co-Authors: LARC Guideline Dev GrpAbstract:BACKGROUND: Long-acting reversible contraceptive (LARC) methods are highly effective in preventing unintended pregnancies. However, their uptake is low in much of the developed world. This study aimed at assessing the cost-effectiveness of LARC methods from the British National Health Service (NHS) perspective. METHODS: A decision-analytic model was constructed to estimate the relative cost-effectiveness of the copper intrauterine device (IUD), the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel Subdermal Implant and the depot medroxyprogesterone acetate injection (DMPA). Comparisons with the combined oral contraceptive pill (COC) and female sterilization were also performed. Effectiveness data were derived from a systematic literature review. Costs were based on UK national sources and expert opinion. RESULTS: LARC methods dominated COC (i.e. they were more effective and less costly). Female sterilization dominated LARC methods beyond 5 years of contraceptive protection. DMPA and LNG-IUS were the least cost-effective LARC methods. The incremental cost-effectiveness ratio of Implant (most effective LARC method) versus IUD (cheapest LARC method) was 13 pound 206 per unintended pregnancy averted for 1 year of use and decreased until Implant dominated IUD in 15 years. Discontinuation was a key determinant of the cost-effectiveness of LARC methods. CONCLUSIONS: LARC methods are cost-effective from the British NHS perspective. Practices improving user satisfaction and continuation of LARC method use should be identified and promoted.
