Each white tablet is a placebo containing only inert ingredients as follows: Oral contraceptives are highly effective. Table 1 lists the typical accidental pregnancy rates for ethynodiol diacetate ethinyl estradiol and propecia of combination oral contraceptives and other methods of contraception.
The efficacy of these contraceptive methods, except sterilization and progestogen implants and injections, depends upon the reliability with which they are used.
Correct and consistent use of methods can result in lower failure rates. LAM is a highly effective, temporary method of contraception.
Trussell J, Contraceptive efficacy. Irvington Publishers,in press, ethynodiol diacetate ethinyl estradiol and propecia. Cervical mucus ovulation method supplemented by calendar in the pre- ovulatory and basal body temperature in the post-ovulatory phases. The Food and Drug Administration has declared the following brands of oral contraceptives to be safe and effective for emergency contraception: To achieve maximum contraceptive effectiveness, oral contraceptives must be taken exactly as directed and at intervals of 24 hours.
If the Sunday start schedule is selected, the patient should be ethynodiol diacetate ethinyl estradiol and propecia to use ethynodiol diacetate ethinyl estradiol and propecia additional method of protection until after the first week of administration in the initial cycle. The possibility of ovulation and conception prior to initiation of use should be considered.
Then the white tablets are taken for 7 days, whether bleeding has stopped or not. After all 28 tablets have been taken, whether bleeding has stopped chitosan and cancer not, ethynodiol diacetate ethinyl estradiol and propecia, the same dosage schedule is repeated beginning on the following day.
If spotting bleeding insufficient to require a padbreakthrough bleeding heavier bleeding similar to a menstrual flowor nausea occurs the patient should continue taking her tablets as directed.
The incidence of spotting, breakthrough bleeding or nausea is minimal, most frequently occurring in the first australian study prostate cancer and soy. Ordinarily spotting or breakthrough bleeding will ethynodiol diacetate ethinyl estradiol and propecia within a week, ethynodiol diacetate ethinyl estradiol and propecia.
Usually the patient will begin to cycle regularly within two to three courses of tablet-taking. In the event of spotting or breakthrough bleeding organic causes should be borne in mind. Withdrawal flow will normally occur 2 or 3 days after the last active tablet is taken.
Failure of withdrawal bleeding ordinarily does not mean that the patient is pregnant, providing the dosage schedule has been correctly followed. If the patient has not adhered to the prescribed dosage regimen, the possibility of pregnancy should be considered after the first missed period, and oral contraceptives should be withheld until pregnancy has been ruled out.
If the patient has adhered to the prescribed regimen and misses two consecutive periods, pregnancy should be ruled out before continuing the contraceptive regimen. The first intermenstrual interval after discontinuing the tablets is usually prolonged; consequently, a patient for whom a 28 day cycle is usual might not begin to menstruate for 35 days or longer.
Ovulation in such prolonged cycles will occur correspondingly later in the cycle. Posttreatment cycles after the first one, however, are usually typical for the individual woman prior to taking tablets. If a woman misses taking one active tablet, the missed tablet should be taken as soon as it is remembered. In addition, the next tablet should be taken at the usual time. If two consecutive active tablets are missed in week 1 or week 2 of the dispenser, the dosage should be doubled for the next 2 days.
The regular schedule should then be resumed, but an additional method of protection must be used as backup for the next 7 days if she has sex during that time or she may become pregnant, ethynodiol diacetate ethinyl estradiol and propecia. If two consecutive active tablets are missed in week 3 of the dispenser or three consecutive active tablets are missed during any of the first 3 weeks of the dispenser, direct the patient to do one of the following: Day 1 Starters should discard the rest of the dispenser and begin a new dispenser that same day; Sunday Starters should continue to take 1 tablet daily until Sunday, discard the rest of the dispenser and begin a new dispenser that same day.
The patient may not have a period this month; however, if she has missed two consecutive periods, pregnancy should be ruled out. An additional method of protection must be used as a backup for the next 7 days after the tablets birth control and spotting missed if she has sex during that time ethynodiol diacetate ethinyl estradiol and propecia she may become pregnant.
While there is little likelihood of ovulation if only one active tablet is missed, the possibility of spotting or breakthrough bleeding is increased and should be expected if two or more successive active tablets are missed.
However, the possibility of ovulation increases with each successive day that scheduled active tablets are missed. If one or more placebo tablets of Zovia are missed, the Zovia schedule should be resumed on the eighth day after the last light yellow tablet was taken.
Omission of placebo tablets in the 28 tablet courses does not increase the possibility of conception provided that this schedule is followed. Each blister card dispenser contains 21 light yellow, round, flatfaced, beveled-edge, unscored tablets, debossed with stylized b on one side and 14 on the other side and 7 white, round, flat-faced, beveled-edge, unscored placebo tablets, debossed with stylized b on one side and on the other side. Each light yellow tablet contains 1 mg of ethynodiol diacetate, USP and 0.
Each white tablet contains inert ingredients. Hatcher RA, et al. New York, NY, Medical Economics Co Inc; Mayne Pharma, Greenville, NC There is evidence of an association between the following conditions and the use of oral contraceptives, although additional confirmatory studies are needed:. The following adverse reactions have been reported in patients receiving oral contraceptives and are believed to be drug-related:.
The following adverse reactions or conditions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted:. Reduced efficacy and increased incidence of breakthrough bleeding and menstrual irregularities have been associated with concomitant use of rifampin. A similar association, though less marked, has been suggested for barbiturates, phenylbutazone, phenytoin sodium, ethynodiol diacetate ethinyl estradiol and propecia, and possibly with griseofulvinampicillinand tetracyclines.
This could result in loss of contraceptive efficacy. Certain endocrine and liver function tests and blood components may be affected by oral contraceptives:. Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use.
This risk increases with age and with heavy smoking 15 or more cigarettes per day and is quite marked in women over ethynodiol diacetate ethinyl estradiol and propecia years of age. Women who use oral contraceptives should be strongly advised not to smoke.
The use of oral contraceptives is associated with increased risk of several serious conditions including venous and arterial thromboembolismthrombotic and hemorrhagic strokeethynodiol diacetate ethinyl estradiol and propecia, myocardial infarctionliver tumors or other liver lesions, and gallbladder disease. The risk of morbidity and mortality increases significantly in the presence of other risk factors such as hypertensionhyperlipidemiaobesityand diabetes mellitus.
Practitioners prescribing oral contraceptives should be familiar with the following information relating to these and other risks. The information contained herein is principally based on studies carried out in patients who used oral contraceptives with formulations containing higher amounts of estrogens and progestogens than those in common use today.
The effect of long-term use of the oral contraceptives with lesser amounts of both estrogens and progestogens remains to be determined. Throughout this labeling, epidemiological studies reported are of two types: Case-control studies provide an estimate of the relative risk of a disease, which is defined as the ratio of the incidence of a disease among oral contraceptive users to that among nonusers.
The relative risk or odds ratio does not provide information about the actual clinical occurrence of a disease. Cohort studies provide a measure of both the relative risk and the attributable risk. The latter is the difference in the incidence of disease ethynodiol diacetate ethinyl estradiol and propecia oral contraceptive users and nonusers.
The attributable risk does provide information about the actual occurrence or incidence of a disease in the subject population. For further information, the reader is referred to a text on epidemiological methods. An increased risk of myocardial infarction has been associated with oral contraceptive use. This increased risk is primarily in smokers or in women with other underlying risk factors for coronary artery disease such as hypertension, obesity, diabetesand hypercholesterolemia.
The relative risk for myocardial infarction in current oral contraceptive users has been estimated to be 2 to 6. The risk is very low under the age of However, there is the possibility of a risk of cardiovascular disease even in very young women who take oral contraceptives.
Smoking in combination with oral contraceptive use has been reported to contribute substantially to the risk of myocardial infarction in women in their mid-thirties or older, with smoking accounting for the majority of excess cases.
Mortality rates associated with circulatory disease have been shown to increase substantially in smokers, especially in those 35 years of age and older among women who use oral contraceptives see Figure 1, Table 2. Circulatory disease mortality rates perwoman-years by age, smoking status, and oral contraceptive use. Oral contraceptives may compound the effects of well-known cardiovascular risk factors such as hypertension, diabetes, hyperlipidemias, hypercholesterolemia, age, cigarette smoking, and obesity.
In particular, some progestogens decrease HDL cholesterol and cause glucose intolerance, while estrogens may create a state of hyperinsulinism.
Similar effects on risk factors have been associated with an increased risk of heart disease. An increased risk of thromboembolic and thrombotic disease associated with the use of oral contraceptives is well established.
A two- to seven-fold increase in relative risk of postoperative thromboembolic complications has been reported with the use of oral contraceptives. Since the immediate postpartum period is also associated with an increased risk of thromboembolism, oral contraceptives should be started no earlier than 4 to 6 weeks after delivery in women who elect not to breastfeed. Both the relative and attributable risks of cerebrovascular events thrombotic and hemorrhagic strokes have been reported to be increased with oral contraceptive use, 14,17,18,34,42,46, although, in general, the risk was greatest among older over 35 yearshypertensive women who also smoked.
Hypertension was reported to be a risk factor for both users and nonusers, for both types of strokes, while smoking increased the risk for hemorrhagic strokes. In one large study, 52 the relative risk for thrombotic boat kits and plans was reported as 9.
It ranged from 3 for normotensive users to 14 for users with severe hypertension. The risk is also greater in older women and among ear staple and weight loss. A positive association has been reported between the amount of estrogen and progestogen in oral contraceptives and the risk of vascular disease.
Because estrogens increase HDL- cholesterolthe net effect of an oral contraceptive depends on the balance achieved between doses of estrogen and progestogen and the nature and absolute amount of progestogens used in the contraceptives.
The amount of both steroids should be considered in the choice of an oral contraceptive. Minimizing exposure to estrogen and progestogen is in keeping with good principles of therapeutics.
For any particular estrogen-progestogen combination, the dosage regimen prescribed should be one that contains the least amount of estrogen and progestogen that is compatible with a low failure rate and the needs of the individual patient.
New acceptors of oral contraceptives should be started on preparations containing the lowest estrogen content that produces satisfactory results in the individual. There are three studies that have shown persistence of risk of vascular disease for users of oral contraceptives. In a study in the United States, the risk of developing myocardial infarction after discontinuing oral contraceptives persisted for at least 9 years for women 40 to 49 years old who had used oral contraceptives for 5 or more years, but this increased risk was not demonstrated in other age groups.
One study 67 gathered data from a variety of sources that have estimated the mortality rates associated with different methods of blood pressure and peripheral resistance at different ages Table 2.
These estimates include the combined risk of death ethynodiol diacetate ethinyl estradiol and propecia with contraceptive methods plus the risk attributable to pregnancy in the event of method failure.
Each method of contraception has its specific benefits and risks. The study concluded that, with the exception of oral contraceptive users 35 and older who smoke and 40 or older who do not smoke, mortality associated with all methods of ethynodiol diacetate ethinyl estradiol and propecia control is low and below that associated with childbirth.