Is spotting on mixed hormone birth control normal?
Intermenstrual bleeding
In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, "mittelschmerz"). This may also occur at the same time as menstrual spotting. The term breakthrough bleeding or breakthrough spotting is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives, in which it refers to bleeding or spotting between any expected withdrawal bleedings, or bleeding or spotting at any time if none is expected. If spotting continues beyond the first three cycles of oral contraceptive use, a woman should have her prescription changed to a pill containing either more estrogen or more progesterone.
Gynecomastia
Chronic exposure (or "in utero" in the case of children with abnormal gynecomastia at birth) to low doses of endocrine disruptors, which mimic estrogen, and/or products that have hormonal and/or toxic impacts on the thyroid or testicles may also have an effect. In 2010 Dumas et al. analyzed the plasma levels of two phthalates, DEHP and its metabolite MEHP, in 39 adolescents with gynecomastia and 20 control subjects without it. DEHP was detected in all samples and its metabolite MEHP as well except in a control sample. A positive correlation existed with blood plasma concentrations of DEHP and MEHP; significantly higher concentrations were found in adolescents who had gynecomastia, with no apparent link to the levels of FSH, LH, SHBG, total and free testosterone hormone. This work was subsequently confirmed by a study on a larger number of adolescents.
Hybrid striped bass
Produced in hatcheries, the most common hybridization is the female striped bass" Morone saxatilis" and the male white bass" M. chrysops". This is due to the high number of eggs produced by the female striped bass. This hybrid cross, palmetto bass, typically produces a faster-growing offspring which attains larger size than the sunshine bass. The female striped bass is injected with human gonadotropin which stimulates her to lay. Usually, around a dozen male white bass are in the tank when the spawn occurs. Once the eggs are fertilized, the brood fish are removed and the eggs must stay adrift in artificial current for about 48 hours to hatch. Natural hybridization occurs between the species, but it is usually the reverse cross which would be male "M. saxatilis" x female "M. chrysops", since the white bass eggs do not require the same degree of flotation to hatch.
Polycystic ovary syndrome
It can be difficult to become pregnant with PCOS because it causes irregular ovulation. Medications to induce fertility when trying to conceive include the ovulation inducer clomiphene or pulsatile leuprorelin. Metformin improves the efficacy of fertility treatment when used in combination with clomiphene. Metformin is thought to be safe to use during pregnancy (pregnancy category B in the US). A review in 2014 concluded that the use of metformin does not increase the risk of major birth defects in women treated with metformin during the first trimester. Liraglutide may reduce weight and waist circumference more than other medications.
Breakthrough bleeding
Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives, as attributed to insufficient estrogens. It may also occur with other hormonal contraceptives. Sometimes, "breakthrough bleeding" is classified as "abnormal" and thereby as a form of metrorrhagia, and sometimes it is classified as "not abnormal".
Testosterone cypionate
Testosterone cypionate, along with other AAS, is a schedule III controlled substance in the United States under the Controlled Substances Act and a schedule IV controlled substance in Canada under the Controlled Drugs and Substances Act.
Premenstrual dysphoric disorder
Another FDA approved treatment for PMDD is the oral contraceptive with ethinylestradiol and drospirenone (a novel progestin) taken on a 24-4 schedule (24 active pills, 4 inactive pills). It has been shown that hormonal birth control containing drospirenone and low levels of estrogen helps relieve severe PMDD symptoms, for at least the first three months it is used. The idea behind using oral contraceptives is to suppress ovulation, therefore suppressing sex hormone fluctuations.
Adolescent sexuality
Teenage girls who use the most common form of birth control pills, combination birth control pills with both estrogen and progestin, are 80% more likely to be prescribed an antidepressant than girls who were not taking birth control. Girls who take progestin-only pills are 120% more likely. The risk of depression is tripled for teenage girls who use non-oral forms of hormonal contraception.
Lucia O’Sullivan and her colleagues studied adolescent sexual functioning; they compared an adolescent sample with an adult sample and found no significant differences between them. Desire, satisfaction and sexual functioning were generally high among their sample of participants (aged 17–21). Additionally, no significant gender differences were found in the prevalence of sexual dysfunction.
In terms of problems with sexual functioning mentioned by participants in this study, the most common problems listed for males were experiencing anxiety about performing sexually (81.4%) and premature ejaculation (74.4%). Other common problems included issues becoming erect and difficulties with ejaculation. Generally, most problems were not experienced on a chronic basis. Common problems for girls included difficulties with sexual climax (orgasm) (86.7%), not feeling sexually interested during a sexual situation (81.2%), unsatisfactory vaginal lubrication (75.8%) anxiety about performing sexually (75.8%) and painful intercourse (25.8%). Most problems listed by the girls were not persistent problems. However, inability to experience orgasm seemed to be an issue that was persistent for some participants.
Etonogestrel birth control implant
Irregular bleeding and spotting: Many women will experience some type of irregular, unpredictable, prolonged, frequent, or infrequent bleeding when using Nexplanon or Implanon. Some women also experience amenorrhea. For some women, prolonged bleeding will decline after the first three months of use. However, other women may experience this bleeding pattern through all three years of use. While these patterns are not dangerous, they are the most common reason that women give for discontinuing the use of the implant. After removal, bleeding patterns return to previous patterns in most women.
Amenorrhea
Certain medications, particularly contraceptive medications, can induce amenorrhoea in a healthy woman. The lack of menstruation usually begins shortly after beginning the medication and can take up to a year to resume after stopping a medication. Hormonal contraceptives that contain only progestogen like the oral contraceptive Micronor, and especially higher-dose formulations like the injectable Depo Provera commonly induce this side effect. Extended cycle use of combined hormonal contraceptives also allow suppression of menstruation. Patients who use and then cease using contraceptives like the combined oral contraceptive pill (COCP) may experience secondary amenorrhoea as a withdrawal symptom. The link is not well understood, as studies have found no difference in hormone levels between women who develop amenorrhoea as a withdrawal symptom following the cessation of COCP use and women who experience secondary amenorrhoea because of other reasons. New contraceptive pills, like continuous oral contraceptive pills (OCPs) which do not have the normal 7 days of placebo pills in each cycle, have been shown to increase rates of amenorrhoea in women. Studies show that women are most likely to experience amenorrhoea after 1 year of treatment with continuous OCP use.
Ethinylestradiol
On the other hand, due to the loss of inactivation of EE by 17β-HSD in the endometrium (uterus), EE is relatively more active than estradiol in the endometrium and, for this reason, is associated with a significantly lower incidence of vaginal bleeding and spotting in comparison. This is particularly so in the case of combined estrogen and progestogen therapy (as in COCs or menopausal HRT), as progestogens induce the expression of 17β-HSD in the endometrium. The reduced vaginal bleeding and spotting with EE is one of the main reasons that it is used in COCs instead of estradiol, in spite of its potentially inferior safety profile (related to its adverse effects on hepatic protein synthesis and VTE incidence).
Ethinylestradiol/norethisterone
Ethinylestradiol/norethisterone, also known as ethinyl estradiol/norethindrone, is a combination birth control pill made up of ethinylestradiol, an estrogen and norethisterone a progestin. It is used for birth control, symptoms of menstruation, endometriosis, and menopausal symptoms. Other uses include acne. It is taken by mouth.
Side effects can include nausea, headache, blood clots, breast pain, depression, and liver problems. Use is not recommended during pregnancy, the initial three weeks after childbirth, and in those at high risk of blood clots. It; however, may be started immediately after a miscarriage or abortion. Smoking while using combined birth control pills is not recommended. It works by stopping ovulation, making the uterus not suitable for implantation, and making the mucus at the opening to the cervix thick.
This combination pill was approved for medical use in the United States in 1964. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. In the United Kingdom three months of medication costs the NHS about 2.70 pounds. In the United States it costs about $25–50 per month. It is marketed under a large number of brand names.
Horse markings
"Birdcatcher spots" are small white spots, usually between 1 mm and in diameter. It is not yet known what controls their expression, although it is believed that they are not genetic. Birdcatcher spots occur in many breeds. These spots may occur late in a horse's life, or may occur and then disappear.
Combined oral contraceptive pill
The hormones in the pill have also been used to treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, acne, hirsutism, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation). Besides acne, no oral contraceptives have been approved by the U.S. FDA for the previously mentioned uses despite extensive use for these conditions.
Spotting
Medicine
Spotted skunk
Around the time of March, the males’ testes begin to enlarge and are most massive by late September. The increase in size is accompanied by a larger testosterone production. Similarly, a female begins to experience an increase in ovarian activity in March. "Spilogale" begin to mate during March as well. Implantation occurs approximately 14–16 days after mating. For the western spotted skunk, most copulations occur in late September and the beginning of October. Post copulation the zygotes are subject to normal cleavage but stop at the blastocyst stage, where they can remain in the uterus for roughly 6.5 months. After implantation, gestation last a 30 days and between April and June their offspring are born. Although litter sizes vary considerably, the average litter size is about 5.5 and the gender ratio is 65 M: 35 F.
Breakthrough bleeding
Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.
Progestogen-only pill
Lacking the estrogen of combined pills, they are not associated with increased risks of deep vein thrombosis or heart disease. With the decreased clotting risk, they are not contraindicated in the setting of sickle-cell disease. The progestin-only pill is recommended over regular birth control pills for women who are breastfeeding because the mini-pill does not affect milk production (estrogen reduces the amount of breast milk). Like combined pills, the minipill decreases the likelihood of pelvic inflammatory disease.
Ethinylestradiol
Birth control pills containing EE have been found to increase circulating SHBG levels by 2- to 4-fold in women and to reduce free testosterone concentrations by 40 to 80%. Birth control pills containing high doses of EE can increase SHBG levels in women by as much as 5- to 10-fold. This is similar to the 5- to 10-fold increase in SHBG levels that occurs during pregnancy. Due to the marked increase in SHBG levels, free testosterone levels become very low during treatment with EE-containing birth control pills. In men, a study found that treatment with a relatively low dosage of 20 μg/day EE for five weeks increased circulating SHBG levels by 150% and, due to the accompanying decrease in free testosterone levels, increased total circulating levels of testosterone by 50% (via upregulation of gonadal testosterone production due to reduced negative feedback by androgens on the hypothalamic–pituitary–gonadal axis). The stimulation of hepatic SHBG production by EE is far stronger than with other estrogens like estradiol, owing to the high resistance of EE to inactivation in the liver and hence its disproportionate effects in this part of the body.
Combined oral contraceptive pill
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. It includes a combination of an estrogen (usually ethinylestradiol) and a progestogen (specifically a progestin). When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.
Birth control
Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with the hope of preventing pregnancy. They work primarily by preventing ovulation or fertilization. They are unlikely to affect implantation, but this has not been completely excluded. A number of options exist, including high dose birth control pills, levonorgestrel, mifepristone, ulipristal and IUDs. Providing emergency contraceptive pills to women in advance does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. All methods have minimal side effects.
Hormonal contraception
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive pill—was first marketed as a contraceptive in 1960. In the ensuing decades many other delivery methods have been developed, although the oral and injectable methods are by far the most popular. Altogether, 18% of the world's contraceptive users rely on hormonal methods. Hormonal contraception is highly effective: when taken on the prescribed schedule, users of steroid hormone methods experience pregnancy rates of less than 1% per year. Perfect-use pregnancy rates for most hormonal contraceptives are usually around the 0.3% rate or less. Currently available methods can only be used by women; the development of a male hormonal contraceptive is an active research area.
Birth control pill formulations
Birth control pills come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogens and synthetic progestogens (progestins), and progestogen only pills. Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestogen changes from week to week.
Breakthrough bleeding
Use of combined estrogen and progesterone eliminates the normal endogenous hormonal cycling and gradually produces atrophy of the endometrial glands. This is because the dosage of estrogen in the OCs pills is much lower than the quantity produced naturally by the ovaries. Higher quantities produced by the ovaries induce proliferation, but low levels supplied by the pills produce atrophy but are sufficient to inhibit the endogenous secretion of the gonadotropins.
The exact chain of events that lead from an atrophic endometrium to the spotting between menses is not explained by the text. This condition may be corrected by using a pill with a higher estrogen (which will stimulate further proliferation of the endometrium) or lower progestin content (which will reduce its stability).
Pharmacodynamics of progesterone
Congenital 5α-reductase 2 deficiency is a rare intersex condition which is associated with ambiguous genitalia in male fetuses due to a deficiency in DHT production during genital differentiation. Experimental prenatal exposure to established 5α-reductase inhibitors like finasteride has been found to produce similar feminized genital defects in male animals including rodents and monkeys. In contrast, exogenous administration of progesterone to pregnant rodents has been found not to produce fetal defects in either male or female pups. In addition, endogenous progesterone levels naturally increase to very high concentrations during pregnancy (e.g., 100-fold by term), yet genital defects do not occur. In accordance, while total concentrations of progesterone in pregnant women at term are around 150 ng/mL (~500 nM), free or unbound and hence bioactive concentrations of progesterone are only about 3 ng/mL (~10 nM) due to the high plasma protein binding of progesterone, and these concentrations are still well below the aforementioned values for inhibition of 5α-reductase types 1 and 2. As with endogenous progesterone during pregnancy, exogenous administration of additional progesterone during pregnancy has been found not to increase the risk of hypospadias in male infants.
Intermenstrual bleeding
Intermittent spotting between periods can result from any of numerous reproductive system disorders.
Hormonal contraception
There are two main types of hormonal contraceptive formulations: "combined methods" which contain both an estrogen and a progestin, and "progestogen-only methods" which contain only progesterone or one of its synthetic analogues (progestins). Combined methods work by suppressing ovulation and thickening cervical mucus; while progestogen-only methods reduce the frequency of ovulation, most of them rely more heavily on changes in cervical mucus. The incidence of certain side effects is different for the different formulations: for example, breakthrough bleeding is much more common with progestogen-only methods. Certain serious complications occasionally caused by estrogen-containing contraceptives are not believed to be caused by progestogen-only formulations: deep vein thrombosis is one example of this.
Medroxyprogesterone acetate
In women, the most common adverse effects of MPA are acne, changes in menstrual flow, drowsiness, and can cause birth defects if taken by pregnant women. Other common side effects include breast tenderness, increased facial hair, decreased scalp hair, difficulty falling or remaining asleep, stomach pain, and weight loss or gain. Lowered libido has been reported as a side effect of MPA in women. DMPA can affect menstrual bleeding. After a year of use, 55% of women experience amenorrhea (missed periods); after 2 years, the rate rises to 68%. In the first months of use "irregular or unpredictable bleeding or spotting, or, rarely, heavy or continuous bleeding" was reported. Unlike the related medication cyproterone acetate, MPA does not appear to be associated with vitamin B12 deficiency. A 2.2- to 3.6-fold increased risk of venous thromboembolism has been observed with DMPA as a contraceptive. However, this could have reflected preferential prescription of DMPA to women considered to be at an increased risk of VTE.
Hormonal contraception
Birth control pills are the most commonly prescribed hormonal treatment for hirsutism, as they prevent ovulation and decrease androgen production by the ovaries. Additionally, estrogen in the pills stimulates the liver to produce more of a protein that binds to androgens and reduces their activity.
Hormone replacement therapy
Institutions and organizations such as the FDA have taken public stances on compounded BHT. The FDA has stated that compounded BHT is unsupported by medical evidence, and its administration is considered false and misleading by the agency. The FDA has expressed concern that unfounded claims of compounded hormones having advantages over CHT mislead women and health care professionals. The approved pharmaceutical preparations used in conventional therapy have been researched to quantify these risks and benefits, and are produced by manufacturers with stringent purity and potency standards.
Leuprorelin
Common side effects of Lupron Injection include redness/burning/stinging/pain/bruising at the injection site, hot flashes (flushing), increased sweating, night sweats, tiredness, headache, upset stomach, nausea, diarrhea, constipation, stomach pain, breast swelling or tenderness, acne, joint/muscle aches or pain, trouble sleeping (insomnia), reduced sexual interest, vaginal discomfort/dryness/itching/discharge, vaginal bleeding, swelling of the ankles/feet, increased urination at night, dizziness, breakthrough bleeding in a female child during the first 2 months of leuprorelin treatment, weakness, chills, clammy skin, skin redness, itching, or scaling, testicle pain, impotence, depression, or memory problems. The rates of gynecomastia with leuprorelin have been found to range from 3 to 16%.
Emergency contraception
The most common side effect reported by users of emergency contraceptive pills was nausea (50.5% of 979 Yuzpe regimen users and 23.1% of 977 levonorgestrel-only users in the 1998 WHO trial; 14.3% of 2,720 levonorgestrel-only users in the 2002 WHO trial); vomiting is much less common and unusual with levonorgestrel-only ECPs (18.8% of 979 Yuzpe regimen users and 5.6% of levonorgestrel-only users in the 1998 WHO trial; 1.4% of 2,720 levonorgestrel-only users in the 2002 WHO trial). Anti-emetics are not routinely recommended with levonorgestrel-only ECPs. If a woman vomits within 2 hours of taking a levonorgestrel-only ECP, she should take a further dose as soon as possible.
Bioidentical hormone replacement therapy
When prescribed by a licensed practitioner, the compounding of bioidentical hormones is controlled by the state pharmacy boards rather than the FDA, and pharmacists are permitted to adjust dose and delivery method according to the prescription. However, the FDA does have authority over the compounded product. In 2001 the FDA surveyed a limited number of compounded preparations, including eight hormone compounds. All three estradiol products passed every test; however, two out of five progesterone products failed at least one test of potency, content or uniformity.
Steroid acne
Steroid acne is an adverse reaction to corticosteroids, and presents as small, firm follicular papules on the forehead, cheeks, and chest. Steroid acne presents with monomorphous pink paupules, as well as comedones, which may be indistinguishable from those of acne vulgaris. Steroid acne is commonly associated with endogenous or exogenous sources of androgen, drug therapy, or diabetes and is less commonly associated with HIV infection or Hodgkin's disease.
Spotted shag
The spotted shag is a medium-sized marine bird. They are usually between high and weigh between . Their bodies are very slim and they have a very distinctive black, decurved, double crest growing on their nape and their forehead. They have a long, slender, orange-brown coloured, hooked bill and yellow-orange feet. The feathers on their bodies are grey and blue. The adults have small black spots on their backs and wings, which gave them their name. Their irises are brown, while the ring around the iris is blue. They have a small patch of bare facial skin between their eyes and bill, which turns green-blue just before breeding season. Furthermore, non-breeding adults do not have crests and have paler underparts. The males and females do look very alike, there is almost no sexual dimorphism. Sexual dimorphism means that the males and females of a species look different and can be easily told apart, which is not the case for the spotted shag. However, the males and females can be told apart by their calls and mating behavior. Normally they do not produce much noise, only when they are at resting, roosting and nesting areas. When they produce sounds, it can be heard as loud grunts. Spotted shags usually fly in V-formation and it is hard to tell males and female apart. In flight, they look slender and pale, while their rump and tail look darker.
It is hard to estimate the total number of spotted shags in New Zealand; estimates are between 10,000 and 50,000 breeding pairs (20,000 to 100,000 birds). In the past, the number of spotted shags has been limited by the availability of food, which caused an increase in number during the late 1980s.
Ethinylestradiol
There are many uses for EE. It is most commonly used as contraception in combined oral contraceptives (COC), also known as birth control, to prevent pregnancy after sex. EE in its birth control formulation is not only used to prevent pregnancy, but can also be used to treat absence of menstruation, symptoms during menstruation, and acne.
Growth hormone
The Drug Enforcement Administration of the US Department of Justice considers off-label prescribing of HGH to be illegal, and to be a key path for illicit distribution of HGH. This section has also been interpreted by some doctors, most notably the authors of a commentary article published in the Journal of the American Medical Association in 2005, as meaning that "prescribing" HGH off-label may be considered illegal. And some articles in the popular press, such as those criticizing the pharmaceutical industry for marketing drugs for off-label use (which is clearly illegal) have made strong statements about whether doctors can prescribe HGH off-label: "Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands." At the same time, anti-aging clinics where doctors prescribe, administer, and sell HGH to people are big business. In a 2012 article in "Vanity Fair", when asked how HGH prescriptions far exceed the number of adult patients estimated to have HGH-deficiency, Dragos Roman, who leads a team at the FDA that reviews drugs in endocrinology, said "The F.D.A. doesn't regulate off-label uses of H.G.H. Sometimes it's used appropriately. Sometimes it's not."
Progestin
Progestins are used in a variety of different forms of hormonal birth control for women, including combined estrogen and progestogen forms like combined oral contraceptive pills, combined contraceptive patches, combined contraceptive vaginal rings, and combined injectable contraceptives; and progestogen-only forms like progestogen-only contraceptive pills ("mini-pills"), progestogen-only emergency contraceptive pills ("day-after pills"), progestogen-only contraceptive implants, progestogen-only intrauterine devices, progestogen-only contraceptive vaginal rings, and progestogen-only injectable contraceptives.
Menstrual cycle
Combined hormonal contraceptives include both an estrogen and a progestogen. Estrogen negative feedback on the anterior pituitary greatly decreases the release of FSH, which makes combined hormonal contraceptives more effective at inhibiting follicular development and preventing ovulation. Estrogen also reduces the incidence of irregular breakthrough bleeding. Several combined hormonal contraceptives—the pill, NuvaRing, and the contraceptive patch—are usually used in a way that causes regular withdrawal bleeding. In a normal cycle, menstruation occurs when estrogen and progesterone levels drop rapidly. Temporarily discontinuing use of combined hormonal contraceptives (a placebo week, not using patch or ring for a week) has a similar effect of causing the uterine lining to shed. If withdrawal bleeding is not desired, combined hormonal contraceptives may be taken continuously, although this increases the risk of breakthrough bleeding.
Bioidentical hormone replacement therapy
The U.S. Food and Drug Administration has warned several pharmacies about making unsubstantiated claims about the safety and effectiveness of compounded hormone products. The North American Menopause Society has stated that compounded bioidentical hormones have not been approved by the FDA; there is no guarantee of purity, potency, efficacy or safety, and they may contain unknown contaminants. The Australian Menopause Society has similarly stated that there is no evidence that bioidentical hormones administered using lozenges are any safer than their approved counterparts. The International Menopause Society has stated "There are no medical or scientific reasons to recommend unregistered 'bioidentical hormones'. The measurement of hormone levels in the saliva is not clinically useful. These ‘customized’ hormonal preparations have not been tested in studies and their purity and risks are unknown."
Medroxyprogesterone acetate
Though not used as a treatment for epilepsy, MPA has been found to reduce the frequency of seizures and does not interact with antiepileptic medications. MPA does not interfere with blood clotting and appears to improve blood parameters for women with sickle cell anemia. Similarly, MPA does not appear to affect liver metabolism, and may improve primary biliary cirrhosis and chronic active hepatitis. Women taking MPA may experience spotting shortly after starting the medication but is not usually serious enough to require medical intervention. With longer use amenorrhea (absence of menstruation) can occur as can irregular menstruation which is a major source of dissatisfaction, though both can result in improvements with iron deficiency and risk of pelvic inflammatory disease and often do not result in discontinuation of the medication.
Estradiol-containing birth control pill
Estradiol, mainly as esters including estradiol valerate, estradiol cypionate, and estradiol enanthate, is the exclusive estrogen used in combined injectable contraceptives.
Estradiol cypionate/medroxyprogesterone acetate
Estradiol cypionate/medroxyprogesterone acetate (EC/MPA), sold under the brand name Cyclofem among others, is a form of combined injectable birth control. It contains estradiol cypionate (EC), an estrogen, and medroxyprogesterone acetate (MPA), a progestin. It is recommended for short-term use and is given once a month by injection into a muscle.
Common side effects of EC/MPA include irregular menstrual periods which typically improves with time. Other side effects include blood clots, headache, hair loss, depression, nausea, and breast pain. Use during pregnancy is not recommended. Use during breastfeeding is likely safe. It works mainly by preventing ovulation.
EC/MPA came into medical use in 1993 with approval in the United States in 2000. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The medication is approved for use in 18 countries. It is used in Mexico, Thailand, and Indonesia, among other countries. It is no longer commercially available in the United States.
Pseudopregnancy
Pseudopregnancy is a normal physiologic process that occurs in female dogs. It is seen 45–60 days after a normal estrous (heat) period. After ovulation, progesterone levels rise. Pseudopregnancy happens when the progesterone levels begin to fall as decreasing progesterone leads to an increase of the hormone prolactin. Prolactin is responsible for the behaviours seen during pseudopregnancy. Dogs may exhibit mothering of toys, nesting or aggression. Mammary development and milk production are common. Pseudopregnancy can also be acutely induced by spaying (removing of ovaries) a dog near the end of estrus. Spaying removes the source of progesterone and induces a rise in prolactin.
HAIR-AN syndrome
"Spironolactone inhibit the actions of testosterone by binding to its receptors." The standard dose for its use is considered to be 50 to 100 mg twice a day. This might lead to irregular menstrual bleeding, which can be improved by oral contraceptives. Flutamide, another antiandorgen that is used to treat HAIR-AN syndrome, but it has risk of hepatotoxicity. Finasteride is a 5α-reductase inhibitor which can reduces the conversion of testosterone to dihydrotestosterone. It is useful in the treatment of hirsutism with a dosages as low as 5 mg per day.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a set of symptoms due to elevated androgens (male hormones) in females. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin. Associated conditions include type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer.
PCOS is due to a combination of genetic and environmental factors. Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition. Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts. Cysts may be detectable by ultrasound. Other conditions that produce similar symptoms include adrenal hyperplasia, hypothyroidism, and high blood levels of prolactin.
PCOS has no cure. Treatment may involve lifestyle changes such as weight loss and exercise. Birth control pills may help with improving the regularity of periods, excess hair growth, and acne. Metformin and anti-androgens may also help. Other typical acne treatments and hair removal techniques may be used. Efforts to improve fertility include weight loss, clomiphene, or metformin. In vitro fertilization is used by some in whom other measures are not effective.
PCOS is the most common endocrine disorder among women between the ages of 18 and 44. It affects approximately 2% to 20% of this age group depending on how it is defined. When someone is infertile due to lack of ovulation, PCOS is the most common cause. The earliest known description of what is now recognized as PCOS dates from 1721 in Italy.
Norethisterone
Due to its weak androgenic activity, norethisterone can produce androgenic side effects such as acne, hirsutism, and voice changes of slight severity in some women at high dosages (e.g., 10 to 40 mg/day). This is notably not the case with combined oral contraceptives that contain norethisterone and EE, however. Such formulations contain low dosages of norethisterone (0.35 to 1 mg/day) in combination with estrogen and are actually associated with improvement in acne symptoms. In accordance, they are in fact approved by the for the treatment of acne in women in the United States. The improvement in acne symptoms is believed to be due to a 2- to 3-fold increase in sex hormone-binding globulin (SHBG) levels and a consequent decrease in free testosterone levels caused by EE, which results in an overall decrease in androgenic signaling in the body.
Bioidentical hormone replacement therapy
The International Menopause Society, American Congress of Obstetricians and Gynecologists, Society of Obstetricians and Gynaecologists of Canada, The Endocrine Society, the North American Menopause Society (NAMS), United States Food and Drug Administration, American Association of Clinical Endocrinologists, American Medical Association, American Cancer Society and the Mayo Clinic have released statements that there is a lack of evidence that the benefits and risks of bioidentical hormones are different from well-studied nonbioidentical counterparts; until such evidence is produced the risks should be treated as if they are similar; and that compounded hormone products may have additional risks related to compounding. A major safety concern in compounded BHT is that there is no requirement to include package inserts, despite the potential for serious adverse effects (including life-threatening adverse effects) associated with HRT. This can lead to consumers being deceived (and harmed), as they are misled into believing that any hormone-related problems and dangers are exclusively related to non-bioidentical hormones, and that compounded BHT is therefore safe and has no side effects. In reality, the risks of bioidentical hormones have not been studied to the extent of non-bioidentical hormones, so the risks are not well-understood. Regulatory bodies require pharmacies to include important safety information with conventional hormone replacement therapy (CHRT) via package inserts.
Isotretinoin
A CDC report published in 2000 showed problems with the Pregnancy Prevention Program and showed that the increase in prescriptions was from off-label use, and prompted Roche to revamp its program, renaming it the "Targeted Pregnancy Prevention Program" and adding label changes like requirements for two pregnancy tests, two kinds of contraception, and for doctors to provide pharmacists with prescriptions directly; providing additional educational materials, and providing free pregnancy tests. The FDA had another advisory meeting in late 2000 that again debated how to prevent pregnant women from being exposed to the drug; dermatologists testified about the remarkable efficacy of the drug, the psychological impact of acne, and demanded autonomy to prescribe the drug; others argued that the drug be withdrawn or much stricter measures be taken. In 2001 the FDA announced a new regulatory scheme called SMART (the System to Manage Accutane Related Teratogenicity) that required Roche to provide defined training materials to doctors, and for doctors to sign and return a letter to Roche acknowledging that they had reviewed the training materials, for Roche to then send stickers to doctors, which doctors would have to place on prescriptions they give people after they have confirmed a negative pregnancy test; prescriptions could only be written for 30 days and could not be renewed, thus requiring a new pregnancy test for each prescription.
Hormonal contraception
Intermediate dose progestogen-only contraceptives, such as the progestogen-only pill Cerazette (or the subdermal implant Implanon), allow some follicular development but much more consistently inhibit ovulation in 97–99% of cycles. The same cervical mucus changes occur as with low dose progestogens.
HGH controversies
The Drug Enforcement Administration of the US Department of Justice considers off-label prescribing of HGH to be illegal, and to be a key path for illicit distribution of HGH. The FDA, as recently as 2012, has issued alerts stating that "FDA-approved HGH can be legally prescribed for a limited number of conditions." The FDA and the Department of Justice have shut down companies and compounding pharmacies that have marketed HGH for off-label purposes - especially for bodybuilding and anti-aging uses. And some articles in the popular press, such as those criticizing the pharmaceutical industry for marketing drugs for off-label use (which is clearly illegal) have made strong statements about whether doctors can prescribe HGH off-label: "Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands."
Estrogen
Binge eating is associated with decreased estradiol and increased progesterone. Klump et al. Progesterone may moderate the effects of low estradiol (such as during dysregulated eating behavior), but that this may only be true in women who have had clinically diagnosed binge episodes (BEs). Dysregulated eating is more strongly associated with such ovarian hormones in women with BEs than in women without BEs.
Turner syndrome
Usually, estrogen replacement therapy is used to spur the growth of secondary sexual characteristics at the time when puberty should onset. While very few women with Turner syndrome menstruate spontaneously, estrogen therapy requires a regular shedding of the uterine lining ("withdrawal bleeding") to prevent its overgrowth. Withdrawal bleeding can be induced monthly, like menstruation, or less often, usually every three months, if the patient desires. Estrogen therapy does not make a woman with nonfunctional ovaries fertile, but it plays an important role in assisted reproduction; the health of the uterus must be maintained with estrogen if an eligible woman with Turner Syndrome wishes to use IVF (using donated oocytes).
Estrogen
Some hair shampoos on the market include estrogens and placental extracts; others contain phytoestrogens. In 1998, there were case reports of four prepubescent African-American girls developing breasts after exposure to these shampoos. In 1993, the FDA determined that not all over-the-counter topically applied hormone-containing drug products for human use are generally recognized as safe and effective and are misbranded. An accompanying proposed rule deals with cosmetics, concluding that any use of natural estrogens in a cosmetic product makes the product an unapproved new drug and that any cosmetic using the term "hormone" in the text of its labeling or in its ingredient statement makes an implied drug claim, subjecting such a product to regulatory action.
Progesterone vaginal ring
Progesterone vaginal ring, also known as progesterone-only vaginal ring, is a form of vaginal ring used for birth control when breastfeeding. Use can begin at four weeks and continue for at least up to a year following childbirth. Failure rates with usual use is about 1.5 per 100 women. It is used within the vagina with one ring lasting three months. The woman is able to place and remove the ring herself.
Side effects include vaginal discharge and pain with urination. It does not appear to be associated with serious side effects. With use menstrual periods often do not resume. It was specifically made for use with breastfeeding as it does not affect milk production. It works by gradually releasing the hormone progesterone.
Progesterone vaginal rings have been approved for medical use since 1998. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. As of 2014 they are available in a number of South and Central American countries. As of 2016 it is not available in the United States. It was developed by the Population Council and is sold under the brand name Progering.
Conjugated estrogens
CEEs are specifically approved in countries such as the United States and Canada for the treatment of moderate to severe vasomotor symptoms (hot flashes) and vulvovaginal atrophy (atrophic vaginitis, atrophic urethritis) associated with menopause, hypoestrogenism due to hypogonadism, ovariectomy, or primary ovarian failure, abnormal uterine bleeding, the palliative treatment of metastatic breast cancer in women, the palliative treatment of advanced androgen-dependent prostate cancer in men, and the prevention of postmenopausal osteoporosis.
Spotted hyena
The spotted hyena is a non-seasonal breeder, though a birth peak does occur during the wet season. Females are polyestrus, with an estrus period lasting two weeks. Like many felid species, the spotted hyena is promiscuous, and no enduring pair bonds are formed. Members of both sexes may copulate with several mates over the course of several years. Males will show submissive behaviour when approaching females in heat, even if the male outweighs his partner. Females usually favour younger males born or joined into the clan after they were born. Older females show a similar preference, with the addition of preferring males with whom they have had long and friendly prior relationships. Passive males tend to have greater success in courting females than aggressive ones. Copulation in spotted hyenas is a relatively short affair, lasting 4–12 minutes, and typically only occurs at night with no other hyenas present. The mating process is complicated, as the male's penis enters and exits the female's reproductive tract through her pseudo-penis rather than directly through the vagina, which is blocked by the false scrotum and testes. These unusual traits make mating more laborious for the male than in other mammals, while also ensuring that rape is physically impossible. Once the female retracts her clitoris, the male enters the female by sliding beneath her, an operation facilitated by the penis's upward angle. Once this is accomplished, a typical mammalian mating posture is adopted. Copulation may be repeated multiple times during a period of several hours. Both partners usually lick their genitals for several minutes after mating.
Hormone replacement therapy
Compounding in the United Kingdom is a regulated activity. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates compounding performed under a Manufacturing Specials license and the General Pharmaceutical Council (GPhC) regulates compounding performed within a pharmacy. All testosterone prescribed in the United Kingdom is bioidentical and its use is supported by the National Health Service (NHS). Marketing authorization exists for male testosterone products. National Institute for Health and Care Excellence (NICE) guideline 1.4.8 states: "consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective". The footnote adds: "at the time of publication (November 2015), testosterone did not have a United Kingdom marketing authorisation for this indication in women. Bio-identical progesterone is used in IVF treatment and for pregnant women who are at risk of premature labour."
A 2017 pooled analysis of data from five observational cohort studies in Swedish women found a reduction in risk of stroke among women who started hormone replacement therapy within five years of onset of menopause. Demographically, the vast majority of data available is in postmenopausal American women with concurrent pre-existing conditions, and with a mean age of over 60 years.
Comparison of birth control methods
Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4–6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Etonogestrel birth control implant
Acne: Acne has been self-reported to be a side effect of Implanon, and is listed as a side effect by the FDA. However, a study of Implanon users found that a majority of users with acne before their insertion reported that their acne had decreased, and only 16% of those who did not have acne before insertion developed acne.
Combined injectable birth control
Combined injectable contraceptives (CICs) are a form of hormonal birth control for women. They consist of monthly injections of combined formulations containing an estrogen and a progestin to prevent pregnancy.
Gestodene
Gestodene, sold under the brand names Femodene and Minulet among others, is a progestin medication which is used in birth control pills for women. It is also used in menopausal hormone therapy. The medication is available almost exclusively in combination with an estrogen. It is taken by mouth.
Side effects of the combination of an estrogen and gestodene include menstrual irregularities, headaches, nausea, breast tenderness, mood changes, and others. Gestodene is a progestin, or a synthetic progestogen, and hence is an agonist of the progesterone receptor, the biological target of progestogens like progesterone. It has weak androgenic activity, weak antimineralocorticoid activity, and weak glucocorticoid activity.
Gestodene was discovered in 1975 and was introduced for medical use, specifically in birth control pills, in 1987. It was subsequently introduced for use in menopausal hormone therapy as well. Gestodene is sometimes referred to as a "third-generation" progestin. It is marketed in birth control pills widely throughout the world, whereas it is available for use in menopausal hormone therapy only a few countries. Gestodene is not approved in the United States.
Spironolactone
In women, menstrual disturbances are common during spironolactone treatment, with 10 to 50% of women experiencing them at moderate doses and almost all experiencing them at a high doses. Most women taking moderate doses of spironolactone develop amenorrhea, and normal menstruation usually returns within two months of discontinuation. Spironolactone produces an irregular, anovulatory pattern of menstrual cycles. It is also associated with metrorrhagia and menorrhagia (or menometrorrhagia) in a large percentage of women. It has no birth control effect. It has been suggested that the weak progestogenic activity of spironolactone is responsible for these effects, although this has not been established and spironolactone has been shown to possess insignificant progestogenic and antiprogestogenic activity even at high dosages in women. An alternative proposed cause is inhibition of 17α-hydroxylase and hence sex steroid metabolism by spironolactone and consequent changes in sex hormone levels. In any case, regardless of their mechanism, the menstrual disturbances associated with spironolactone can usually be controlled well by concomitant treatment with a birth control pill, due to the progestin component.
Organizational-Activational Hypothesis
Finger ratio has been examined in relation to a number of physical traits that show sex differences and evidence suggests it is influenced by the prenatal environment, although there is no direct evidence for the latter. Studies in men have been motivated by two conflicting hypotheses. On the one hand, homosexual men were hypothesized to be exposed to high levels of testosterone in utero, which would be associated with a lower 2D:4D ratio than that found in heterosexual men. On the other hand, homosexual men have been hypothesized to have low prenatal testosterone exposure, and data from two studies are consistent with that hypothesis, showing homosexual men to have a higher finger ratio (on both hands) than heterosexual men. 
The hormonal control of ovulation is also related to the organizational/activational hypothesis. Both males and females rats exhibit luteinizing hormone (LH) pulses in which LH is released from the anterior pituitary due to the secretion of gonadotropin releasing hormone (GnRH) from the hypothalamus. Females, however, show an increase in LH pulse frequency around ovulation due to the positive feedback mechanism. When estrogen is increased in the blood, the anteroventral periventricular nucleus (AVPV) of the hypothalamus causes the release of GnRH. The GnRH surge brings about a surge in LH and follicle stimulating hormone (FSH). Since females have a cyclic gonadal function, there may be a sexual dimorphism in the gonadal secretion. When female rats are injected with testosterone there is no positive feedback occurring and no LH surge. Moreover, castrated males will exhibit LH surges, similar to female cyclic gonadal behavior.
Birth control pill formulations
All contain an estrogen, ethinylestradiol or mestranol, in varying amounts, and one of a number of different progestogens. (Regarding the estrogen, the inactive 3-methyl ether of ethinylestradiol, which must be metabolized by the liver into the active ethinylestradiol; 50 µg of mestranol is equivalent to only 35 µg of ethinylestradiol and should not be used when high-dose [50 µg ethinylestradiol] estrogen pills are needed; mestranol was the estrogen used in the first oral contraceptive, Enovid). They are usually taken for 21 days with then a seven-day gap during which a withdrawal bleed (often, but incorrectly, referred to as a menstrual period) occurs. These differ in the amount of estrogen given, and whether they are monophasic (the same dose of estrogen and progestogen during each of the 21 days) or multiphasic (varying doses). The introduction of extended-cycle monophasic pills (i.e. Seasonale) has shown that the withdrawal bleeding intervals can be decreased.
Contraceptive patch
On November 10, 2005 Ortho McNeil, in conjunction with the FDA, revised the label for Ortho Evra, including a new bolded warning about higher exposure to estrogen for women using the weekly patch compared to taking a daily birth control pill containing 35 µg of estrogen, noting that higher levels of estrogen may put some women at increased risk for getting blood clots. The label was again revised in September 2006, and on January 18, 2008, the FDA again updated the label to reflect study results. "The FDA believes that Ortho Evra is a safe and effective method of contraception when used according to the labeling, which recommends that women with concerns or risk factors for serious blood clots talk with their health care provider about using Ortho Evra versus other contraceptive options."
Combined oral contraceptive pill
Since it is not uncommon for menstruating women to become anemic, some placebo pills may contain an iron supplement. This replenishes iron stores that may become depleted during menstruation.
List of combined sex-hormonal preparations
This is a list of known combined sex-hormonal formulations. Brand names and developmental code names are in parentheses.
In birth control pills:For menopausal hormone therapy:In birth control pills:In contraceptive patches:For menopausal hormone therapy:In contraceptive vaginal rings:In combined injectable contraceptives:For menopausal hormone therapy, gynecological disorders, habitual abortion, and other indications:In combined injectable contraceptives:
Polycystic ovary syndrome
Medications for PCOS include oral contraceptives and metformin. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. This reduces the symptoms of hirsutism caused by high testosterone and regulates return to normal menstrual periods. Metformin is a medication commonly used in type 2 diabetes mellitus to reduce insulin resistance, and is used off label (in the UK, US, AU and EU) to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and return to normal ovulation. Spironolactone can be used for its antiandrogenic effects, and the topical cream eflornithine can be used to reduce facial hair. A newer insulin resistance medication class, the thiazolidinediones (glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile. The United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. Metformin may not be effective in every type of PCOS, and therefore there is some disagreement about whether it should be used as a general first line therapy. In addition to this, metformin is associated with several unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting. The use of statins in the management of underlying metabolic syndrome remains unclear.
British Spotted pony
The spotted colouration does not always breed true, as two spotted animals may produce a solid-coloured foal. Many spotted animals are not registered because they lack a visible white sclera or striped hooves.
Emergency contraception
Emergency contraception has not been shown to affected the rates of abortion within a country.
Emergency contraceptive pills (ECPs) (sometimes referred to as emergency hormonal contraception, EHC) may contain higher doses of the same hormones (estrogens, progestins, or both) found in regular combined oral contraceptive pills. Taken after unprotected sexual intercourse or contraceptive failure, such higher doses may prevent pregnancy from occurring.
Menstruation
Progestogen-only contraceptive pills (sometimes called the 'mini pill') are taken continuously without a 7-day span of using placebo pills, and therefore menstrual periods are less likely to occur than with the combined pill with placebo pills. However, disturbance of the menstrual cycle is common with the mini-pill; 1/3-1/2 of women taking it will experience prolonged periods, and up to 70% experience break-through bleeding (metrorrhagia). Irregular and prolonged bleeding is the most common reason that women discontinue using the mini pill.
Ovulation induction
Ovulation induction in the sense of reversing anovulation or oligoovulation is indicated for women who do not ovulate on their own regularly, such as those with Polycystic ovary syndrome (PCOS). The medication which is most commonly used to treat anovulation is clomifene citrate (or clomid), which is a selective estrogen receptor modulator (SERM) that increases production of gonadotropins by inhibiting negative feedback from estrogen on the hypothalamus.
Combined injectable birth control
The following are marketed CICs at different doses than those that are approved:The half-progestin-dose formulation of estradiol valerate/norethisterone enantate (5 mg / 25 mg) is also known as HRP-103 and the half-progestin-dose formulation of estradiol cypionate/medroxyprogesterone acetate (5 mg / 12.5 mg) is also known as HRP-113.
Hypomenorrhea
Reduced menstrual flow is a common side-effect of hormonal contraception methods, such as oral contraceptive pills, IUDs that release hormones (such as Mirena), or hormonal implants such as Depo-Provera. The relatively low estrogen contained in most hormonal contraceptives reduces the growth of the endometrium, so there is relatively little endometrium left to be shed during menstruation. Many women find this side-effect to be a benefit of hormonal contraceptive use.
Hormonal contraception
While combined contraceptives increase the risk for deep vein thrombosis (DVT - blood clots), progestogen-only contraceptives are not believed to affect DVT formation.Combined oral contraceptives can increase the risk of certain types of cardiovascular disease in women with a pre-existing condition or already-heightened risk of cardiovascular disease. Smoking (for women over 35), metabolic conditions like diabetes, obesity and family history of heart disease are all risk factors which may be exacerbated by the use of certain hormonal contraceptives.
Combined injectable birth control
The most prominent side effects of CICs are menstrual irregularities during the first 3 to 6 months of use.
Heavy menstrual bleeding
The condition is often treated with hormones, particularly as abnormal uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually, oral combined contraceptive or progesterone only pills may be taken for a few months, but for longer-term treatment the alternatives of injected Depo Provera or the more recent progesterone releasing IntraUterine System (IUS) may be used. Fibroids may respond to hormonal treatment, and if they do not, then surgical removal may be required.
Spotted owl
The spotted owl's breeding season occurs from early spring to late summer or fall, with prelaying behaviors such as preening and roosting together starting in February or March.
Spotted owl pairs are monogamous and rarely renest after failed breeding attempts. The species does not normally breed every year, with average breeding probability being 62%. Young owls may start breeding at an age of one year, but two years or older is more common. Normal clutch size is two eggs, but may reach four on rare occasions. The female sits on the eggs and cares for the young, while the male provides food for them. Egg incubation times of about a month have been reported from western Oregon; time from fledging to independence of chicks is between three and four months. Once independent, juveniles disperse in late summer to fall, in the northern range often settling into a wintering range before seeking out breeding territories in the spring. Dispersal range is often less than .
Polycystic ovary syndrome
If fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill. The purpose of regulating menstruation, in essence, is for the woman's convenience, and perhaps her sense of well-being; there is no medical requirement for regular periods, as long as they occur sufficiently often.
Birth control
There are a number of common misconceptions regarding sex and pregnancy. Douching after sexual intercourse is not an effective form of birth control. Additionally, it is associated with a number of health problems and thus is not recommended. Women can become pregnant the first time they have sexual intercourse and in any sexual position. It is possible, although not very likely, to become pregnant during menstruation.
Hair care
During pregnancy and breast feeding, the normal and natural shedding process is typically suspended (starting around month three because it takes a while for the body to recognize and reset for the hormonal shifts the body goes through) for the period of gestation and extended longer if one breast feeds (this includes pumping for breast milk). Upon cessation of either of these, it typically takes around two months for the hormones to shift again to the normal hormonal settings, and hair shedding can increase exponentially, for approximately 3–6 months until hair returns to its normal volume. It is commonly noticed that hair seems thicker and shinier, even, during pregnancy and breast feeding in response to the influx of shifting hormones. It is not unusual also for hair color to change, or hair structure to change (e.g., straighter hair, curlier hair). These changes can occur more often than people may realize yet isn't often reported.
Vitex agnus-castus
The most frequent adverse effects from vitex use include nausea, headache, gastrointestinal discomfort, menstrual discomfort, fatigue, and skin disorders. People taking dopamine-related medications or Parkinson’s disease medications should avoid using chasteberry. Women on birth control pills, hormone replacement therapy, or having a hormone-sensitive condition, such as breast cancer, are advised not to use chasteberry. Use of vitex is discouraged for pregnant or breastfeeding women, and for children.
Extended cycle combined hormonal contraceptive
Other combined hormonal contraceptives (those containing both an estrogen and a progestin) may also be used in an extended or continuous cycle. For example, the NuvaRing vaginal ring and the contraceptive patch have been studied for extended cycle use, and the monthly combined injectable contraceptive may similarly eliminate bleeding.
Comparison of birth control methods
For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or for some reason not take the pill one or several days, or not go to the pharmacy on time to renew the prescription, or the pharmacy might be unwilling to provide enough pills to cover an extended absence.
Lipohypertrophy
It is a common misconception that the lump is largely scar tissue, as injection site hypertrophy is much rarer and milder with injections of other hormones and medications which lack the specific ability of insulin to stimulate adipose hypertrophy.
Birth control pill formulations
Combination pills usually work by preventing the ovaries from releasing eggs (ovulation). They also thicken the cervical mucus, which keeps sperm from penetrating into the uterus and joining with an egg. The hormones in combination and progestogen-only pills also thin the lining of the uterus. This could prevent pregnancy by interfering with implantation of a blastocyst.
Mifepristone
Nearly all women using the mifepristone/misoprostol regimen experienced abdominal pain, uterine cramping, and vaginal bleeding or spotting for an average of 9–16 days. Up to 8% of women experienced some type of bleeding for 30 days or more. Other less common side effects included nausea, vomiting, diarrhea, dizziness, fatigue, and fever. Pelvic inflammatory disease is a very rare but serious complication. Excessive bleeding and incomplete termination of a pregnancy require further intervention by a doctor (such as vacuum aspiration). Between 4.5 and 7.9% of women required surgical intervention in clinical trials. Mifepristone is contraindicated in the presence of an intrauterine device, as well as with ectopic pregnancy, adrenal failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term corticosteroid therapy.
Vaginal ring
When compared with combined hormonal pills, the combined hormonal vaginal ring offers potentially better cycle control and treatment of heavy menstrual bleeding. However, both methods are effective short-term treatments in the reproductive age group. Vaginal rings may lead to increased normal vaginal secretions, decreased body weight, reduced symptoms of PMS, and occasionally cases of vaginitis, device-related problems and leukorrhea. Because they release estrogen, vaginal rings have an increased risk of heart attack, stroke, and other serious side effects. Additionally, certain medicines and supplements, such as the antibiotic rifampin, the anti-fungal griseofulvin, anti-seizure medicines, St. John's wort, and HIV medicines, may compromise the effectiveness of vaginal rings. Vaginal rings do not protect users from sexually transmitted diseases. The only contraceptive measures that does so are latex or polyurethane condoms.
Estrogen (medication)
Estrogens have contraceptive effects and are used in combination with progestins (synthetic progestogens) in birth control to prevent pregnancy in women. This is referred to as combined hormonal contraception. The contraceptive effects of estrogens are mediated by their antigonadotropic effects and hence by inhibition of ovulation. Most combined oral contraceptives contain ethinylestradiol or its prodrug mestranol as the estrogen component, but a few contain estradiol or estradiol valerate. Ethinylestradiol is generally used in oral contraceptives instead of estradiol because it has superior oral pharmacokinetics (higher bioavailability and less interindividual variability) and controls vaginal bleeding more effectively. This is due to its synthetic nature and its resistance to metabolism in certain tissues such as the intestines, liver, and uterus relative to estradiol. Besides oral contraceptives, other forms of combined hormonal contraception include contraceptive patches, contraceptive vaginal rings, and combined injectable contraceptives. Contraceptive patches and vaginal rings contain ethinylestradiol as the estrogen component, while combined injectable contraceptives contain estradiol or more typically an estradiol ester.
Medroxyprogesterone acetate
Medroxyprogesterone acetate (MPA), also known as depot medroxyprogesterone acetate (DMPA) and sold under the brand name Depo-Provera among others, is a hormonal medication of the progestin type. It is used as a method of birth control and as a part of menopausal hormone therapy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer. The medication is available both alone and in combination with an estrogen. It is taken by mouth or by injection into a muscle or fat.
Common side effects include menstrual disturbances such as absence of periods, abdominal pain, and headaches. More serious side effects include bone loss, blood clots, allergic reactions, and liver problems. Use is not recommended during pregnancy as it may harm the baby. MPA is an artificial progestogen, and as such activates the progesterone receptor, the biological target of progesterone. It also has weak glucocorticoid activity and very weak androgenic activity but no other important hormonal activity. Due to its progestogenic activity, MPA decreases the body's release of gonadotropins and can suppress sex hormone levels. It works as a form of birth control by preventing ovulation.
MPA was discovered in 1956 and was introduced for medical use in the United States in 1959. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is about US$0.59–1.57 per vial. In the United Kingdom this dose costs the NHS about 6.01 pounds. In the United States it costs less than $25 a dose as of 2015. MPA is the most widely used progestin in menopausal hormone therapy and in progestogen-only birth control. DMPA is approved for use as a form of long-acting birth control in more than 100 countries.
Long-acting reversible contraception
Contraceptive implants may cause irregular bleeding which some women find unacceptable as a side-effect ("Irregular bleeding and spotting common in first 6 months" associated with IUS; similar to side-effects observed with IUD, injection or implant. "Changes in bleeding pattern which are likely to remain irregular") or a complete cessation of menstrual flow (amenorrhea). Side effects that are observed less often may include emotional lability, weight gain, headache, and acne.
Contraceptive patch
Because the Ortho Evra patch works similar to that of birth control pills, many of the benefits are the same. For example, the patch may make a woman's period lighter and more regular. It may also help to clear acne, decrease cramps, and reduce PMS symptoms. Additionally, the patch is associated with an increased protection against iron deficiency anemia, ovarian cysts, pelvic inflammatory disease, and endometrial and ovarian cancer.
Bioidentical hormone replacement therapy
Compounded BHT is used almost exclusively in the United States, and many FDA-approved formulations that are wholly or partially made of bioidentical hormones are available. Topical hormone preparations such as progesterone, estrogen and DHEA creams can be purchased in stores or over the internet and are not regulated by the FDA, as they are generally considered cosmetic.
Ethinylestradiol/levonorgestrel
Ethinylestradiol/levonorgestrel (also ethinyl estradiol/levonorgestrel) is a combined birth control pill made up of ethinylestradiol, an estrogen and levonorgestrel a progestin. It is used for birth control, symptoms of menstruation, endometriosis, and as emergency contraception. It is taken by mouth.
Side effects can include nausea, headache, blood clots, breast pain, depression, and liver problems. Use is not recommended during pregnancy, the initial three weeks after childbirth, and in those at high risk of blood clots. However, it may be started immediately after a miscarriage or abortion. Smoking while using combined birth control pills is not recommended. It works by stopping ovulation, making the mucus at the opening to the cervix thick, and making the uterus not suitable for implantation.
Ethinylestradiol/levonorgestrel has been approved for medical use in the United States at least since 1982. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. In the United Kingdom three months of medication costs the NHS about 1.80 pounds. In the United States it costs about $25–50 per month. It is marketed under a large number of brand names.
Estradiol enantate
The combination of 10 mg estradiol enantate and 150 mg DHPA as a once-monthly combined injectable contraceptive (which achieves levels of estradiol of around 350 pg/mL) has been found to have little to no effect on many markers of estrogen-modulated liver protein synthesis including circulating levels of HDL and LDL cholesterol, copper, ceruloplasmin, total and free cortisol, corticosteroid-binding globulin, and sex hormone-binding globulin. However, it was found to significantly increase levels of triglycerides and to significantly decrease levels of total and free testosterone. In contrast to the combined injectable contraceptive, an ethinylestradiol-containing birth control pill produced highly significant changes in all of the preceding parameters.
Melasma
Pregnant women often get melasma, or chloasma, known as the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma. The discoloration usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.
Chlormadinone acetate
The most common side effects of birth control pills containing EE and low-dose CMA have been found to include menstrual abnormalities, headache (37%), nausea (23%), breast tenderness (22%), and vaginal discharge (19%) among others. These formulations do not adversely affect sexual desire or function in women and show little or no risk of depression, mood swings, or weight gain. High-dosage CMA is associated with sexual dysfunction (e.g., reduced libido, erectile dysfunction), reduced body hair, adrenal insufficiency, and alterations in carbohydrate metabolism. Conversely, it does not share adverse effects of estrogens such as breast discomfort and gynecomastia. CMA does not increase the risk of venous thromboembolism. There is a case report of autoimmune progesterone dermatitis with CMA. Similarly to other progestins but in contrast to progesterone, CMA has been found to significantly increase the risk of breast cancer when used in combination with an estrogen in menopausal hormone therapy. No abnormalities in liver function tests have been observed in women taking combined birth control pills containing CMA or CPA. Unlike CPA, high-dosage CMA does not seem to be associated with hepatotoxicity.
Ovulatory shift hypothesis
As ovulatory shifts are predicted to be caused by changes in sex hormones across the menstrual cycle, they may be affected by the use of hormonal contraceptives. Studies often report that women who use hormonal birth control experience weaker or nonexistent ovulatory shifts in thoughts and behavior.
Combined oral contraceptive pill
Combined oral contraceptive pills are a type of oral medication that is designed to be taken every day, at the same time of day, in order to prevent pregnancy. There are many different formulations or brands, but the average pack is designed to be taken over a 28-day period, or cycle. For the first 21 days of the cycle, users take a daily pill that contains hormones (estrogen and progestogen). The last 7 days of the cycle are hormone free days. Some packets only contain 21 pills and users are then advised to take no pills for the following week. Other packets contain 7 additional placebo pills, or biologically inactive pills. Some newer formulations have 24 days of active hormone pills, followed by 4 days of placebo (examples include Yaz 28 and Loestrin 24 Fe) or even 84 days of active hormone pills, followed by 7 days of placebo pills (Seasonale). A woman on the pill will have a withdrawal bleed sometime during her placebo pill or no pill days, and is still protected from pregnancy during this time. Then after 28 days, or 91 days depending on which type a person is using, users start a new pack and a new cycle.
Birth control
Improvements of existing birth control methods are needed, as around half of those who get pregnant unintentionally are using birth control at the time. A number of alterations of existing contraceptive methods are being studied, including a better female condom, an improved diaphragm, a patch containing only progestin, and a vaginal ring containing long-acting progesterone. This vaginal ring appears to be effective for three or four months and is currently available in some areas of the world. For women who rarely have sex, the taking of the hormonal birth control levonorgestrel around the time of sex looks promising.