Instruct: Given a question, retrieve relevant passages that answer the question.
Query: Is spotting on mixed hormone birth control normal?
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.
In a series of relatively small studies of the combination of low-dose CPA and ethinylestradiol as a birth control pill, depression was reported to have occurred in 1.3 to 4% of cycles. This is similar to the rate of mood changes (<3.5%) observed with birth control pills containing other progestins. A pharmacoepidemiological study using data from the United Kingdom General Practice Research Database found that the incidence of depression with birth control pills containing CPA was identical to that of birth control pills containing other progestins ( = 0.99). In clinical studies of the combination of low-dose CPA and estradiol valerate for the treatment of menopausal symptoms, preexisting adverse mood symptoms have been found to be significantly improved.
Contraception has many benefits beyond preventing pregnancy. Combination estrogen-progestin contraceptives can successfully treat dysmenorrhea (painful periods), provide symptom relief from endometriosis, reduce heavy menstrual bleeding and improve anemia related to menstrual blood loss, reduce symptoms of premenstrual syndrome and premenstrual dysphoric disorder, reduce ovarian and colon cancer risk, reduce moderate acne, prevent of menstrual migraines, and reduce hirsutism (abnormal hair growth). The progestin containing intrauterine device can reduce heavy menstrual bleeding and protect against pre-cancerous changes or cancer in the uterus. Condoms (male or female) are the only contraceptive method which protects against acquisition of sexually transmitted infections.
Maternity blues, also known as baby blues and postpartum blues, is a transient condition that 75-80% of mothers could experience shortly after childbirth with a wide variety of symptoms which generally involve mood lability, tearfulness, and some mild anxiety and depressive symptoms. Baby blues is not postpartum depression, unless it is abnormally severe.After the placenta is delivered, the placental "hormone factory" shuts down causing radical changes in hormone levels, and the woman can suffer symptoms due to withdrawal from the high pregnancy levels of estrogen, progesterone and endorphins. Combined with this shift in hormone levels is the physical, mental and emotional exhaustion - as well as sleep deprivation typical of parenting a newborn. All of these factors contribute to the condition.
Elevated serum follicle stimulating hormone (FSH) level measured on day three of the menstrual cycle. (First day of period flow is counted as day one. Spotting is not considered start of period.) If a lower value occurs from later testing, the highest value is considered the most predictive. FSH assays can differ somewhat so reference ranges as to what is normal, premenopausal or menopausal should be based on ranges provided by the laboratory doing the testing. Estradiol (E2) should also be measured as women who ovulate early may have elevated E2 levels above 80 pg/mL (due to early follicle recruitment, possibly due to a low serum inhibin B level) which will mask an elevated FSH level and give a false negative result.
The U.S. Food and Drug Administration rejected pleconaril in 2002 due to the side effects. The most commonly reported side effects were mild to moderate headache, diarrhea, and nausea. Some women were having symptoms of spotting in between periods. Menstrual irregularities were reported by 3.5% of the 320 pleconaril treated women using oral contraceptives and by none of the 291 placebo treated women. In the clinical trial two women became pregnant due to the drug interfering with hormonal birth control. Other patients have described painful nasal inflammation. Another side effect of the Pleconaril drug trials was activation of cytochrome P-450 3A enzymes.
Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. Menopause can be divided into early and late transition periods, also known as perimenopause and postmenopause. Each stage is marked by changes in hormonal patterns, which can induce menopausal symptoms. It is possible to induce menopause prematurely by surgically removing the ovary or ovaries (oophorectomy). This is often done as a consequence of ovarian failure, such as ovarian or uterine cancers. The most common side effects of the menopausal transition are: lack of sexual desire or libido, lack of sexual arousal, and vaginal dryness. The modification of women’s physiology can lead to changes in her sexual response, the development of sexual dysfunctions, and changes in her levels of sexual desire.
Xenoestrogens are clinically significant because they can mimic the effects of endogenous estrogen and thus have been implicated in precocious puberty and other disorders of the reproductive system.
Oxytocin (Oxt) is a peptide hormone and neuropeptide. Oxytocin is normally produced by the paraventricular nucleus of the hypothalamus and released by the posterior pituitary. It plays a role in social bonding, sexual reproduction, childbirth, and the period after childbirth. Oxytocin is released into the bloodstream as a hormone in response to stretching of the cervix and uterus during labor and with stimulation of the nipples from breastfeeding. This helps with birth, bonding with the baby, and milk production. Oxytocin was discovered by Henry Dale in 1906. Its molecular structure was determined in 1952. Oxytocin is also used as a medication to facilitate childbirth.
Menstruation is the most visible phase of the menstrual cycle and its beginning is used as the marker between cycles. The first day of menstrual bleeding is the date used for the last menstrual period (LMP). The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women, and 21 to 31 days in adults (an average of 28 days).
The effect on sexual desire is varied, with increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps. The lower doses of estrogen released from the vaginal ring may reduce the risk of breast tenderness, nausea, and headache associated with higher dose estrogen products.
Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than the injectable version should be used. Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect milk production. Irregular bleeding may occur with progestin-only methods, with some users reporting no periods. The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line. The perfect use first-year failure rate of injectable progestin is 0.2%; the typical use first failure rate is 6%.
During the subacute postpartum period, psychological disorders may emerge. Among these are postpartum depression, posttraumatic stress disorder, and in rare cases, puerperal psychosis. Postpartum mental illness can affect both mothers and fathers, and is not uncommon. Early detection and adequate treatment is required. Approximately 25% – 85% of postpartum women will experience the "blues" for a few days. Between 7% and 17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Prevalence of PTSD following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8 and 5.6% at 6 weeks postpartum.
Menstruation in mammals is the shedding of the uterine lining (endometrium). It occurs on a regular basis in uninseminated sexually reproductive-age females of certain mammal species.
Most female mammals have an estrous cycle, yet only ten primates species, four bats species, the elephant shrew, and the spiny mouse have a menstrual cycle. The relatedness of these groups suggests that four distinct evolutionary events have caused menstruation to arise.
This is the most common cause of anovulation and is thought to account for about 70% of all cases. About half the women with hormonal imbalances do not produce enough follicles to ensure the development of an ovule, possibly due to poor hormonal secretions from the pituitary gland or the hypothalamus. The pituitary gland controls most other hormonal glands in the human body. Therefore, any pituitary malfunctioning affects other glands under its influence, including the ovaries. This occurs in around 10% of cases. The mammary glands are also controlled by the pituitary gland, so lactation can also be affected. The pituitary gland is controlled by the hypothalamus. In 10% of cases, alterations in the chemical signals from the hypothalamus can easily seriously affect the ovaries.
In addition to single-drug formulations, oral estradiol valerate is available in combination with the progestin dienogest as a combined oral contraceptive and intramuscular estradiol valerate is marketed in combination with the progestins hydroxyprogesterone caproate and norethisterone enantate as combined injectable contraceptives. Intramuscular estradiol valerate has also been marketed in combination with testosterone enantate, but this formulation has been discontinued. The availability of estradiol valerate-containing products varies throughout the world.
Moudgal's early researches at the University of Madras were on the biochemistry of thyroid hormones but he shifted his focus to pituitary gonadotropins during his days at Choh Hao Li's laboratory at the University of California, Berkeley when he established that the hormones generated immune response in living beings and the discovery was reported to be a significant one as the belief till then was the principal function of the hormones was reproduction. Later, at Rodney Porter's laboratory in London, he worked on the role of cellulose as a carrier for immobilization of antibodies. Back in India, he expanded the scope of his researches to cover wider aspects of reproductive biology for which he established a Primate Research Laboratory at IISc in 1965, which was the largest primate house in the country at that time. Working on the macaques in his primate house, he discovered that sialidase from the kidney of the primate acted as an inhibitor of follicle stimulating hormone (FSH), a hormone responsible for pubertal development. He conducted elaborate studies on the molecular mechanism of Luteinizing Hormone (LH), a hormone which has significant role in ovulation and testosterone production, and elucidated the "unfolding of LH binding to LH receptors in the target cell" which was detailed in one of his articles, "Effect of ICSH on Early Pregnancy in Hypophysectomized Pregnant Rats", published in Nature in 1969. He discovered that neutralizing LH resulted in neutralization of several reproductive functions such as ovulation, implantation, and gestational progress and the discovery opened a new methodology in immunocontraceptive technology. Later, he furthered his investigations on hormone actions by using antibodies as probes. His findings reportedly prompted R. O. Greep of Harvard University to invite him for collaborative research and Moudgal supervised the work of Greep's Group at his laboratory. At Harvard, he also collaborated with W. R. Moyle and established the presence of Luteinizing hormone/choriogonadotropin receptors on tumor cells in the testicles for the first time, which they revealed in an article, "Specific binding of luteinizing hormone to Leydig tumor cells", published in the Journal of Biological Chemistry in 1971. He used these tumor cells for further investigations on Hormone-Receptor interactions, Cyclic adenosine monophosphate (cyclic AMP) production and steroidogenesis and experimentally demonstrated the extent of coupling and response with regard to cyclic AMP production and steroid output.
The length of a woman's menstrual cycle typically varies somewhat, with some shorter cycles and some longer cycles. A woman who experiences variations of less than eight days between her longest cycles and shortest cycles is considered to have regular menstrual cycles. It is unusual for a woman to experience cycle length variations of more than four days. Length variation between eight and 20 days is considered as moderately irregular cycles. Variation of 21 days or more between a woman's shortest and longest cycle lengths is considered very irregular.
Estradiol enantate, sold under the brand names Perlutal and Topasel among others, is an estrogen medication which is used in hormonal birth control. It is formulated in combination with dihydroxyprogesterone acetophenide (DHPA; algestone acetophenide), a progestin, and is used as a combined injectable contraceptive. Estradiol enantate is not available alone. The medication is given by injection into muscle once a month.
Side effects of estradiol enantate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. The drug is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. Estradiol enantate is an estrogen ester and a long-lasting prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol enantate was first described by 1954, and was first studied in combination with DHPA as a combined injectable contraceptive in 1964. The combination was introduced for clinical use by the mid-1970s. Estradiol enantate is not available as a standalone medication (i.e., by itself without DHPA). The combination is available in Latin America and Hong Kong, and was also previously marketed in Spain and Portugal.
A 2019 systematic review and meta-analysis found an incidence rate of VTE of 2.3 per 1000 person-years with feminizing hormone therapy in transgender women. For comparison, the rate in the general population has been found to be 1.0–1.8 per 1000 person-years and the rate in premenopausal women taking birth control pills has been found to be 3.5 per 1000 patient-years. As such, it appears that the risk of VTE with feminizing hormone therapy in transgender women is less than that with birth control pills. The risk of VTE with birth control pills in premenopausal women is considered to be an acceptable level of risk. There was significant heterogeneity in the rates of VTE across the included studied, and the meta-analysis was unable to perform subgroup analyses between estrogen type, estrogen route, estrogen dosage, concomitant antiandrogen or progestogen use, or patient characteristics (e.g., age, smoking status, weight) corresponding to known risk factors for VTE. Due to the inclusion of some studies using ethinylestradiol, which is more thrombotic and is no longer used in transgender women, the researchers noted that the VTE risk found in their study is likely to be an overestimate.
Although the goal of the program is to prevent pregnancies of women who take the drug, male patients must also participate in anti-pregnancy restrictions, primarily due to fears that male isotretinoin users might share their prescriptions with females without their physicians' knowledge. There has been no link to birth defects from Accutane associated with males using the drug, though male sexual dysfunction has been suggested by one study. As this has not been conclusively proven, this is not acknowledged as a side effect in the official literature accompanying the medication.
Intrauterine device (IUD) with progestogen, sold under the brand name Mirena among others, is a intrauterine device that releases the hormone levonorgestrel. It is used for birth control, heavy menstrual periods, and to prevent excessive build of the lining of the uterus in those on estrogen replacement therapy. It is one of the most effective forms of birth control with a one-year failure rate around 0.2%. The device is placed in the uterus and lasts three to five years. Following removal fertility returns quickly.
Side effects include irregular periods, benign ovarian cysts, pelvic pain, and depression. Rarely uterine perforation may occur. Use is not recommended during pregnancy but is safe with breastfeeding. The IUD with progestogen is a type of long-acting reversible birth control. It works by making the mucus at the opening to the cervix thick, stopping the buildup of the lining of the uterus, and occasionally preventing ovulation.
The IUD with levonorgestrel was first approved for medical use in 1990 in Finland and 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 wholesale cost in the developing world is about US$122.46 each. In the United Kingdom they cost the NHS about £88 pounds. In the United States they cost around US$844.00. More than 120 countries have approved the device and it is used by more than 10 million women.
, Lake is working with director Abby Epstein on a documentary about the dangers of hormonal birth control, titled "Sweetening the Pill". The film is based on Holly Grigg-Spall's upcoming 2015 book titled "Sweetening The Pill Or How We Became Hooked On Hormonal Birth Control". The film will explore the flurry of lawsuits related to these methods, as well as alternative options such as Natural Family Planning. Lake and Epstein said, "now [hormonal birth control is] making women sick and so our goal with this film is to wake women up to the unexposed side effects of these powerful medications and the unforeseen consequences of repressing women's natural cycles."
Hormonal contraception is available in a number of different forms, including oral pills, implants under the skin, injections, patches, IUDs and a vaginal ring. They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and a progestin) and the progestogen-only pills (sometimes called minipills). If either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects. Both types of birth control pills prevent fertilization mainly by inhibiting ovulation and thickening cervical mucus. They may also change the lining of the uterus and thus decrease implantation. Their effectiveness depends on the user's adherence to taking the pills.
Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots. Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke. Due to the increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots.
TSH concentrations in children are normally higher than in adults. In 2002, the NACB recommended age-related reference limits starting from about 1.3 to 19 µIU/mL for normal-term infants at birth, dropping to 0.6–10 µIU/mL at 10 weeks old, 0.4–7.0 µIU/mL at 14 months and gradually dropping during childhood and puberty to adult levels, 0.3–3.0 µIU/mL.