Contraceptive efficacy and clinical performance of Nestorone implants in postpartum women

Massai, Marı́a Rebeca; Dı́az, Soledad; Quinteros, Eliana; Reyes, María Verónica; Herreros, C.; Zepeda, Ana; Croxatto, Horacio B.; Moo-Young, Alfred J.

doi:10.1016/s0010-7824(01)00259-1

Cited by 36 publications

(14 citation statements)

References 20 publications

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“…A study on the clinical performance of NES implant in 100 breastfeeding women reported no pregnancy [65], The advantage of Nestorone implants in the postpartum period would be high as the progestin is not active orally, destroyed quickly after oral ingestion and any small amount ingested by the infant through the mother’s milk will be inactivated rapidly. No effect of NES on lactation and infant growth and no serious adverse events were observed in the long-term study comparing the NES implant to the T-Cu IUD [65]. Lactational amenorrhea was significantly longer in NES users (353 ± 20 days) than in T-Cu users (201 ± 11 days).…”

Section: Female Contraceptionmentioning

confidence: 99%

Contraception technology: past, present and future

2013

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Steady progress in contraception research has been achieved over the past 50 years. Hormonal and non-hormonal modern contraceptives have improved women’s lives by reducing different health conditions that contributed to considerable morbidity. However the contraceptives available today are not suitable to all users and the need to expand contraceptive choices still exists. Novel products such as new implants, contraceptive vaginal rings, transdermal patches and newer combinations of oral contraceptives have recently been introduced in family planning programs and hormonal contraception is widely used for spacing and limiting births. Concerns over the adverse effects of hormonal contraceptives have led to research and development of new combinations with improved metabolic profile. Recent developments include use of natural compounds such as estradiol (E2) and estradiol valerate (E2V) with the hope to decrease thrombotic risk, in combination with newer progestins derived from the progesterone structure or from spirolactone, in order to avoid the androgenic effects. Progesterone antagonists and progesterone receptor modulators are highly effective in blocking ovulation and preventing follicular rupture and are undergoing investigations in the form of oral pills and in semi long-acting delivery systems. Future developments also include the combination of a contraceptive with an antiretroviral agent for dual contraception and protection against sexually transmitted diseases, to be used before intercourse or on demand, as well as for continuous use in dual-protection rings. Alhough clinical trials of male contraception have reflected promising results, limited involvement of industry in that area of research has decreased the likelihood of having a male method available in the current decade. Development of non-hormonal methods are still at an early stage of research, with the identification of specific targets within the reproductive system in ovaries and testes, as well as interactions between spermatozoa and ova. It is hoped that the introduction of new methods with additional health benefits would help women and couples with unmet needs to obtain access to a wider range of contraceptives with improved acceptability.

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Section: Female Contraceptionmentioning

confidence: 99%

Contraception technology: past, present and future

2013

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“…Three studies reported on infant outcomes of mothers using nonorally available progestogens, none new. Infant growth was no different in users of nesterone pellets compared with nonhormonal methods [63]; neither infant growth nor health was different between users of progesterone pellets and users of nonhormonal methods [54]. Similarly, there was no difference in infant growth or development between infants of users of nesterone implants and Cu-IUD users [64].…”

Section: Multiple Progestogen-only Methodsmentioning

confidence: 92%

“…Three studies, none new, assessed the impact of nonorally available progestogens (progesterone pellets and nesterone or elcometrine implants) on breastfeeding outcomes. In two of these, breastfeeding duration was similar between women using progesterone pellets [54] or a nesterone implant [63], compared with Cu-IUD. Elcometrine implant users had a higher rate of breastfeeding at 3 and 6 months and similar rates at 9-12 months compared with Cu-IUD users [64].…”

Section: Popsmentioning

confidence: 93%

Progestogen-only contraceptive use among breastfeeding women: a systematic review

2010

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Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes. Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs. Search strategy: We searched the PubMed database for all articles published from database inception through December 2014. Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, injectables, implants or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects). Results: Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breastfeeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association. Conclusion: The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems or impaired development. Evidence newly added to this review was largely consistent with previous evidence.

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“…Use of the NES implant did not show any serious adverse events on lactation and infant growth [84]. These systems have not been fully developed but the NES implant is being tested in China in family planning programs.…”

Section: Intrauterine Contraceptionmentioning

confidence: 99%

Applying emerging science to contraception research: implications for the clinic

Sitruk-Ware

Nath

2014

Expert Review of Endocrinology & Metabolism

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Emerging science will make an important contribution towards the development of improved contraceptives. While long-acting reversible contraceptives remain the most effective method, new user-controlled, mid-acting methods will avoid the need for procedures requiring trained providers. Contraceptives combined with other agents may bring additional health benefits, such as dual protection against both pregnancy and sexually transmitted infections. Emerging research areas in proteomics allowed the discovery of new reproductive targets that may lead to non-hormonal contraceptives for both men and women. Current research objectives include the improvement of existing contraceptive methods, as well as discovery of new materials able to deliver new molecules more specifically to their target without systemic actions.

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Contraceptive efficacy and clinical performance of Nestorone implants in postpartum women

Cited by 36 publications

References 20 publications

Contraception technology: past, present and future

Contraception technology: past, present and future

Progestogen-only contraceptive use among breastfeeding women: a systematic review

Applying emerging science to contraception research: implications for the clinic

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