Levonorgestrel - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

LEVONORGESTREL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AME...

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LEVONORGESTREL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Levonorgestrel: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00658-8 1. Levonorgestrel-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on levonorgestrel. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LEVONORGESTREL .................................................................................... 3 Overview........................................................................................................................................ 3 Federally Funded Research on Levonorgestrel............................................................................... 3 E-Journals: PubMed Central ....................................................................................................... 12 The National Library of Medicine: PubMed ................................................................................ 12 CHAPTER 2. NUTRITION AND LEVONORGESTREL .......................................................................... 61 Overview...................................................................................................................................... 61 Finding Nutrition Studies on Levonorgestrel.............................................................................. 61 Federal Resources on Nutrition ................................................................................................... 62 Additional Web Resources ........................................................................................................... 63 CHAPTER 3. PATENTS ON LEVONORGESTREL ................................................................................. 65 Overview...................................................................................................................................... 65 Patents on Levonorgestrel............................................................................................................ 65 Patent Applications on Levonorgestrel ........................................................................................ 70 Keeping Current .......................................................................................................................... 71 CHAPTER 4. BOOKS ON LEVONORGESTREL .................................................................................... 73 Overview...................................................................................................................................... 73 Book Summaries: Online Booksellers........................................................................................... 73 CHAPTER 5. PERIODICALS AND NEWS ON LEVONORGESTREL ....................................................... 75 Overview...................................................................................................................................... 75 News Services and Press Releases................................................................................................ 75 Academic Periodicals covering Levonorgestrel ............................................................................ 77 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 79 Overview...................................................................................................................................... 79 U.S. Pharmacopeia....................................................................................................................... 79 Commercial Databases ................................................................................................................. 80 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 85 Overview...................................................................................................................................... 85 NIH Guidelines............................................................................................................................ 85 NIH Databases............................................................................................................................. 87 Other Commercial Databases....................................................................................................... 89 APPENDIX B. PATIENT RESOURCES ................................................................................................. 91 Overview...................................................................................................................................... 91 Patient Guideline Sources............................................................................................................ 91 Finding Associations.................................................................................................................... 92 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 95 Overview...................................................................................................................................... 95 Preparation................................................................................................................................... 95 Finding a Local Medical Library.................................................................................................. 95 Medical Libraries in the U.S. and Canada ................................................................................... 95 ONLINE GLOSSARIES................................................................................................................ 101 Online Dictionary Directories ................................................................................................... 101 LEVONORGESTREL DICTIONARY ........................................................................................ 103 INDEX .............................................................................................................................................. 131

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with levonorgestrel is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about levonorgestrel, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to levonorgestrel, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on levonorgestrel. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to levonorgestrel, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on levonorgestrel. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LEVONORGESTREL Overview In this chapter, we will show you how to locate peer-reviewed references and studies on levonorgestrel.

Federally Funded Research on Levonorgestrel The U.S. Government supports a variety of research studies relating to levonorgestrel. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to levonorgestrel. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore levonorgestrel. The following is typical of the type of information found when searching the CRISP database for levonorgestrel: •

Project Title: ADOLESCENT CONTRACEPTION

MISCONCEPTIONS

ABOUT

HORMONAL

Principal Investigator & Institution: Clark, Liana R.; Assistant Professor; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 191044399 Timing: Fiscal Year 2002; Project Start 15-JUL-1999; Project End 30-JUN-2004

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Summary: PROFESSIONAL GOAL: The overall goal of this patient-oriented research career development award proposal is to contribute to the professional, academic, and research development of Dr. Liana Clark. In addition to the proposed project exploring the concerns and misconceptions about hormonal contraception, Dr. Clark will also pursue research training at the University of Pennsylvania. She will take courses toward the Master's degree in Clinical Epidemiology and Biostatistics, as well as courses in bioethics and financial issues in medicine. Under the mentorship of Dr. Loretta Jemmott, Dr. Clark hopes to use this award to establish herself as an academic leader in the area of adolescent sexual risk behaviors. SPECIFIC AIMS OF CONTRACEPTION PROJECT: This project will use both cross sectional and longitudinal study design to: a) identify the attitudes, concerns and misconceptions of adolescents regarding hormonal methods of contraception (Norplant, Depo-Provera and the oral contraceptive pill); b) determine the gender, racial/ethnic, sexual history, and sociodemographic factors associated with attitudes, concerns and misconceptions about hormonal contraception; and c) determine how strongly these attitudes, concerns and misconceptions predict nonuse of, or noncompliance with hormonal contraception. This study will have two parts: (1) a baseline component that includes three stages designed to identify adolescent attitudes, concerns and misconceptions about hormonal contraception and the gender, racial/ethnic, sexual history, sociodemographic features associated with holding such concerns; and (2) a follow-up component to determine whether hormonal contraceptive use and/or compliance is related to attitudes, concerns and misconceptions about these methods of contraception. HYPOTHESES: 1. The majority of adolescents studied will have concerns and misconceptions about hormonal contraception. 2. Minority adolescents (African-American and Hispanic) will have greater negative attitudes, concerns and misconceptions about hormonal contraception than will white nonHispanic adolescents. 3. Adolescents who have strongly negative attitudes, concerns and misconceptions about hormonal contraception will be less likely to choose to use these methods. 4. Adolescents who have negative attitudes, concerns and misconceptions about hormonal contraception will be less compliant with the use of these methods. CONCLUSIONS: By targeting the negative attitudes, concerns and misconceptions regarding hormonal contraception, we will be better able to encourage use of these highly effective methods by adolescents. Increased usage and improved compliance with Depo-Provera, Norplant and the oral contraceptive pill will result in an overall decrease in the rate of unintended adolescent pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARRAGUARD-LEVONORGESTREL COMBINATION -- DUAL PROTECTION Principal Investigator & Institution: Sitruk-Ware, Regine L.; Executive Director Contraceptive Develop; Population Council 1 Dag Hammarskjold Plaza New York, Ny 10017 Timing: Fiscal Year 2002; Project Start 30-AUG-2002; Project End 28-FEB-2007 Summary: (provided by applicant): There is an urgent need for a vaginal product that would not only protect against AIDS and other sexually transmitted infections, but would also prevent conception. We propose to develop such a product by combining the microbicide Carraguard, which is the sulfated polysaccharide, carrageenan, with the synthetic progestin, levonorgestrel (LNG). Laboratory studies have shown that Carraguard is highly effective in blocking HIV in vitro and in mice has effectively protected against vaginal and rectal infection by herpes simplex virus-2 and has blocked infection by Neisseria gonorrhoeae. Carraguard has also prevented human

Studies

5

papillomavirus infection in human xenografts. Its extensive history of safety and stability as a food additive and a pharmaceutical excipient and its physcial properties, allowing Carraguard to act as a vehicle as well as a microbicide, make this agent an ideal candidate for use in a microbicide/contraceptive combination. The progestogen component, LNG, used by women worldwide for 30 years, has a proven record of contraceptive efficacy and safety. Another important feature of LNG is its long half-life, which may allow for occasional use of the combination gel "on demand" before intercourse. The proposed project will include in vitro and animal studies to evaluate the compatibility of the two agents in the CARRA/LNG formulation, regarding hormone release, stability of components and the formulation, and microbicidal and contraceptive efficacy. The proposed clinical studies will establish proof of concept of CARRA/LNG, vaginal retention profile, the feasibility of vaginal administration, the pharmacokinetic profile, safety and acceptability. The clinical studies will target three modes of contraception: 1) contraception on demand, delivering two high doses of CARRA/LNG during the follicular phase to delay the LH peak and to alter cervical mucus thus inhibiting sperm penetration; 2) induction of local effects (e.g., alteration of cervical mucus and transformation of the endometrium) using daily-low dose LNG in the combined product, which would prevent sperm penetration and implantation; and 3) induction of a systemic effect with daily use of high-dose LNG delivered via Carraguard gel that would decrease LH and FSH and suppress ovulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DOXYCYCLINE CONTRACEPTORS

FOR

BLEEDING

IN

PROGESTIN

ONLY

Principal Investigator & Institution: Archer, David F.; Director, Clinical Research Center; Obstetrics and Gynecology; Eastern Virginia Medical School Norfolk, Va 23507 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Clinically, a high percentage of women using progestin-only contraception experience breakthrough bleeding spotting that causes impaired lifestyle and results in decreased compliance with this contraceptive method. There is a need for an effective, low-cost, easily adapted treatment to reduce the bleeding and spotting in progestin only contraceptives. The molecular environment of the endometrium of women with breakthrough bleeding [BTB] and spotting, like many other inflammatory disorders, contains abnormally high levels of pro-inflammatory cytokines (TNF-alpha and IL-1beta)and abnormally high levels of proteases (matrix metalloproteinases [MMPs] and neutrophil elastase), which prevent normal tissue repair. Doxycycline [DOX] is an inexpensive, FDA approved antibiotic that inhibits MMPs, TACE activity, and reduces NO synthesis. The therapeutic benefit of DOX in animal models and clinical studies of periodontal and ulcerative diseases is due to its inhibition of MMPs, not to its antibiotic effect. We do not anticipate any reduction in contraceptive efficacy with the use of DOX. We propose to clinically evaluate DOX treatment of progestin-only contraceptive induced BTB and spotting, and to biochemically characterize the endometrial molecular biologic changes that occur in DOX treated patients. If successful, DOX treatment could become an important adjuvant for treatment of this and possibly other inflammatory disorders effecting reproductive tract tissues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LEVONORGESTREL TABLET AS EMERGENCY CONTRACEPTIVE Principal Investigator & Institution: Creinin, Mitchell D.; Associate Professor; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: This is a prospective open-label multicenter trial in which the objective is to evaluate levonorgestrel as the only method of emergency contraception. Levonorgestrel 0.75 was administered as 2 doses of 1 tablet each given 12 hours apart to qualifying women who presented within 72 hours after unprotected intercourse. Subjects will be followed until their next menstrual period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BLEEDING

MIFEPRISTONE

FOR

PREVENTION

OF

BREAKTHROUGH

Principal Investigator & Institution: Jain, John K.; Assistant Professor; Obstetrics & Gynecology; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 30-JUN-2005 Summary: (provided by applicant): Progestin-only contraceptives such as depomedroxyprogesterone acetate (DMPA) represent one of the most effective classes of contraceptives but are limited by high discontinuation rates due to breakthrough bleeding especially during the first year of use. Mifepristone is a competitive progesterone receptor antagonist. When Mifepristone was given to normally cycling primates, a near-amenorrheic state was achieved. Mifepristone has been shown to decrease breakthrough bleeding in women using levonorgestrel implants. Although estrogen receptor expression increases after Mifepristone administration, a paradoxical anti-proliferative effect is seen in the endometrium. That has lead some investigators to conclude that mifeprisone can suppress estrogen receptor transcriptional activity through non-competitive means such as sequestration of estrogen receptor transcriptional cofactors. The result being lack of endometrial proliferation and development of an atrophic endometrial state. With less endometrial tissue to shed, bleeding diminishes and amenorrhea ensues. We propose to conduct a 14-month prospective, randomized, double-blind, placebo-controlled study of 50 mg of Mifepristone administered every 2 weeks for 12 cycles to 50 new starters of DMPA in order to determine the incidence of bleeding and ovulation. Bleeding data will be gathered with the use of daily dairies and ovulation monitored by thrice-weekly urine collections. Seven endometrial biopsies obtained pre- and post - treatment will be analyzed using immunohistochemical and quantitative RT-PCR methods to evaluate levels of estrogen and progesterone receptor isoforms. Biopsies will also be evaluated histologically. In order to determine the function of estrogen receptors following DMPA and Mifepristone we will establish primary endometrial cell culture and test estrogen function by measuring markers of proliferation such as SRC, MIB-1 and MMT and correlating results to in vivo biopsy samples. We are currently conducting a pilot study similar to the one proposed to gather preliminary data and to test the feasability of a larger trial. If Mifepristone is shown to safely decrease the incidence of breakthrough bleeding, more women may continue DMPA and not place themselves at risk of an unintended pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

Project Title: NOVEL CONTRACEPTIVES

CONTROLLED

DELIVERY

SYSTEMS

7

FOR

Principal Investigator & Institution: Singh, Jagdish P.; Pharmaceutical Sciences; North Dakota State University Fargo, Nd 581055756 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2006 Summary: (provided by applicant): Subdermal implants for controlled delivery of contraceptive hormones have become the target of litigation in recent years for causing a variety of problems in users. These problems include purported serious side effects and complications during insertion and removal. A well-developed contraceptive hormone delivery system must limit the burst effect on injection, release the hormone within the therapeutic requirements for the duration of treatment, ease of administration, biodegradable, and cost effectiveness of the manufacturing process. Smart polymer solution based delivery systems would meet all the above requirements. The long-term goal of this project is to develop smart polymer solution based controlled delivery systems to deliver contraceptive hormones after single subcutaneous injection at predefined rate for longer duration. We propose to test the hypotheses that phase and temperature sensitive, reversibly gel forming, biodegradable, smart polymers can control the in vitro and in vivo release of hormone and the proposed smart polymer based delivery systems are biocompatible. To test our hypotheses, we plan to study the following specific aims: (1) To synthesize temperature sensitive triblock copolymers and characterize them for critical gel concentration, gel transition temperature (i.e., lower critical solution temperature), weight average molecular weight by gel permeation chromatography, and number average molecular weight by 1H NMR; (2) To prepare in situ gel forming smart polymer solution based controlled delivery systems for levonorgestrel and testosterone, using phase sensitive and temperature sensitive polymers; (3) To study in vitro release profiles of levonorgestrel and testosterone from delivery systems; (4) To evaluate the biocompatibility of the above delivery systems in vitro, using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay; and (5) To study in vivo absorption of the above hormones from delivery systems in rabbits. We believe that the present study has potential to result in novel and improved approaches for parenteral controlled release delivery systems for contraceptive hormones. Development of such a novel therapeutic system is critical for successful treatment of hormone-related diseases and improvement in the patients' quality-of-life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORAL ADOLESCENT GIRLS

CONTRACEPTIVES

FOR

DYSMENORRHEA

IN

Principal Investigator & Institution: Davis, Anne R.; Obstetrics and Gynecology; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: (Adapted from applicant's description) This is an initial application submitted by a new investigator. Primary dysmenorrhea is defined as pain during the menses in the absence of a pathologic lesion and is probably caused by prostaglandin effects on the uterus. Primary dysmenorrhea is highly prevalent among adolescents. More than 50% of adolescent girls in various populations report dysmenorrhea which is severe in about 15%. Dysmenorrhea is a major cause of morbidity in adolescents leading to activity restriction and school absence. Combined oral contraceptives (COC) are a common treatment for primary dysmenorrhea. Some small laboratory studies show

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Levonorgestrel

decreased prostaglandins associated with COC use compared to non-COC use. Larger observational studies show a lower prevalence of dysmenorrhea among COC users compared to non-COC users and improved dysmenorrhea after initiating open-label COC use. In the only randomized, double blind, placebo-controlled trial, Matthews showed modest improvement of dysmenorrhea among a small number of women using a high- dose COC compared to placebo (1968). None of the existing studies compare the efficacy of a low-dose COC with placebo in the treatment of primary dysmenorrhea. The proposed study is a double blind, randomized, placebo-controlled trial to determine the efficacy of a low-dose COC in the treatment of primary dysmenorrhea among urban, adolescent girls. Healthy girls aged 19 years or less with moderate to severe dysmenorrhea as determined by the Robinson modification of the Andersch scale will be eligible (Robinson, 1992). 150 girls will be randomized to receive either a COC containing 20 micrograms ethinyl estradiol and 0.1 milligrams levonorgestrel or a placebo. The main effect will be change in score on the pain sub-scale of the Moos Menstrual Distress Questionnaire (MDQ) after three months of treatment. This study will have 80% power to detect a 50% reduction in pain score with an alpha of.05 and a drop-out rate of 40%. Secondary outcome measures will be changes in school absence, activity restriction and medication use. Also, we plan to determine if psychological measures of depression, life-crisis events or self- concept ratings predict response to treatment. Given their efficacy in pregnancy prevention, safety, and non-contraceptive health benefits, COC may be an ideal therapy for primary dysmenorrhea in adolescent girls. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHARMACOKINETICS OF ORAL LEVONORGESTREL (LNG) IN FEMALE CYNOMOLGUS MACAQUES Principal Investigator & Institution: Lasley, Bill L.; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 956165200 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RCT OF LNG-IUD VS. DMPA FOR YOUNG POSTPARTUM WOMEN Principal Investigator & Institution: Stanwood, Nancy L.; Obstetrics and Gynecology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2004; Project Start 01-SEP-2004; Project End 31-AUG-2006 Summary: (provided by applicant): The U.S. has the highest unintended pregnancy rate of any developed country, mostly in teens and women in their early twenties due to ineffective contraceptive use. Once a young woman has given birth, helping her choose an effective method of postpartum contraception is crucial to preventing an unintended pregnancy. The injectable depomedroxyprogesterone acetate (DMPA) is a highly effective method of contraception, with better compliance and lower pregnancy rates than oral contraceptives. It is commonly recommended to young women for postpartum contraception. However, up to 50% of women stop using it in the first year due to the side effects of irregular bleeding and perceived weight gain. Clinicians also have concerns that DMPA may worsen depression and inhibit maximum bone density in young women. The levonorgestrel intrauterine device (LNG-IUD) is a very effective, well-tolerated contraceptive. It has not been traditionally considered in this population due to a false perception that IUDs lead to a long-term increased risk of pelvic

Studies

9

inflammatory disease (PID). Modern evidence counters these fears, suggesting that LNG-IUD may actually decrease the risk of PID. Its performance as a postpartum contraceptive for young women merits evaluation. We aim to perform a pilot randomized trial of 30 women aged 14 to 25 years comparing postpartum DMPA and LNG-IUD with regard to method continuation and side effects. We also aim to assess the recruitment of postpartum young women for randomization between DMPA and LNG-IUD, measuring the number needed to screen to enroll and randomize one subject. We will recruit subjects during the third trimester of prenatal care and will follow them for one year postpartum for the outcomes of method continuation, unintended pregnancy rate, menstrual complaints, patient satisfaction, complications and side effects. The best postpartum method of contraception is one that works well and that women continue to use. The LNG-IUD is highly effective and has high patient satisfaction and continuation rates in older women. Whether younger women find it satisfactory for postpartum contraception and continue to use it is unknown. If this pilot is successful, we plan to perform a larger trial powered to detect a difference in continuation rates between DMPA and LNG-IUD. Such a study could provide evidence for the safe and effective use of LNG-IUD in young postpartum women, leading to fewer unintended pregnancies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR BREAST CANCER IN YOUNGER NURSES Principal Investigator & Institution: Willett, Walter C.; Chairman; Nutrition; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2004; Project Start 17-JUL-1989; Project End 31-MAR-2009 Summary: (provided by applicant): We propose to continue the follow-up of 116,678 women, who were 25 to 42 years of age in 1989 when enrolled in the prospective Nurses' Health Study II, which was designed to identify potentially modifiable determinants of breast cancer risk in young women. In this unique cohort, information on oral contraceptive use, diet, physical activity, and other exposures has been collected at twoyear intervals with 90% or greater response to each follow-up questionnaire. Since the initiation of the cohort, we have collected blood (stored as plasma, red cells, and buffy coats for DNA) and urine samples from approximately 30,000 participants and detailed data on current and high school diet. Important findings have emerged on animal fat consumption and use of oral contraceptive preparations containing levonorgestrel. In the present proposals, we will address several hypotheses relating specific nutritional factors during high school and early adult life (assessed as dietary intakes and blood levels), acrylamide intake from dietary sources, use of specific formulations of oral contraceptives, shift work and melatonin excretion, lifetime physical activity, exclusive breast feeding, and plasma cysteine levels to risk of pre- and postmenopausal breast cancer. These analyses will incorporate specific gene-environment interactions and the methylation status of BRCA-1 in tumor blocks. To carry out these aims and expand the core resources, we propose to collect buccal cell samples for DNA from 30,000 participants who did not provide blood. With follow-up though 2007, we anticipate a total of 2773 incident cases of breast cancer, including 1946 in premenopausal women, which will provide adequate power to address these issues. The follow-up of this population will provide women and their health care providers with information critical for informed decisions regarding use of oral contraceptives, diet, and other aspects of lifestyle, and will also contribute to better understanding of the etiology and prevention of breast cancer in young women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Levonorgestrel

Project Title: SUPPRESSION OF BREAKTHROUGH BLEEDING IN LNG-IUS USERS Principal Investigator & Institution: Brenner, Robert M.; Senior Scientist; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The Mirena(c) (Leiras, OY, Finland) is an intrauterine system (IUS) that releases levonorgestrel (LNG) and provides women with highly effective contraception for 5 years. However, serious breakthrough bleeding (BTB) can occur that leads many patients to discontinue treatment. In women using subcutaneous Norplant contraception, BTB can be suppressed by intermittent antiprogestin therapy with mifepristone. NICHD has a new antiprogestin, CDB-2914, that is more potent than mifepristone. The goal of this proposal is to determine whether CDB-2914 can suppress the BTB associated with the LNG-IUS. Preclinical studies will be done first in rhesus macaques fitted with an LNG-IUS and the information gained will be transmitted to Professor Hilary Critchley, University of Edinburgh, who will select a test population of 150 women from a pool of over 400 who are being fitted annually with an LNG-IUS for contraception. The bleeding-suppressive dose and schedule of CDB-2914 that works well in macaques will be adapted for use in women. The work consists of two major aims: Aim 1: to establish an effective, bleeding-suppressive dose schedule of CDB 2914 in macaques, and to assess spatio-temporal expression of bleeding-associated factors in the endometrium. Aim 2: to conduct a randomized, placebo controlled trial to evaluate CDB-2914 suppression of BTB in women being fitted with the LNG-IUS; and for added value, to develop a questionnaire to assess acceptability of the proposed treatment to women. This proposal involves translation of the information gained from basic research with macaques into clinical practice in women within the time frame of the grant. It is essential to conduct the clinical work at the University of Edinburgh, Scotland, UK, because no clinic in the USA has such a large patient population of women being fitted with the LNG-IUS for contraception. The macaque model provides excellent predictability for human studies, and Drs. Brenner and Critchley have published collaboratively on data from macaques and women in several recent papers. The proposal brings basic scientists and clinicians together for a "bench to bedside" approach that will advance women's health and improve contraceptive technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSDERMAL CONTRACEPTION

LEVONORGESTREL

FOR

EMERGENCY

Principal Investigator & Institution: Nichols, L D.; Biotek, Inc. Woburn, Ma 01801 Timing: Fiscal Year 2002; Project Start 28-SEP-1999; Project End 30-APR-2005 Summary: (Scanned from the applicant's description): This program seeks to develop a transdermal system capable of delivering 1,500 ug of levonorgestrel over the course of 24 hours through two 30 cm2 patches. Such a system should be as effective for emergency contraception as the currently approved oral method, while offering greater convenience and fewer side effects. Although the required transdermal dose is high for a drug as insoluble as levonorgestrel, BIOTEK's past experience suggested that it could be achieved. Phase I began with an in vitro study on human skin to confirm and optimize high levonorgestrel fluxes, continued with a study of irritation and bioavailability in rabbits, and concluded with an evaluation of materials for use in comfortable patches capable of maintaining good skin contact over a large area. These

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tasks were successfully completed. The Phase II work proposed here will complete patch design work, prepare and characterize GMP patches, submit an IND, and conclude with a 10-subject human clinical dose ranging study of safety, follicular response, and levonorgestrel pharmacokinetics at the Jones Institute of the Eastern Virginia Medical School. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UNDERSTANDING OVARIAN CONTROL IN RARE BIOMEDICAL MODELS Principal Investigator & Institution: Pelican, Katharine M.; Smithsonian Institution Po Box 37012, Mrc 903 Washington, Dc 200137012 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The candidate in this application will receive stateof-the art training while advancing scholarly knowledge on ovarian cycle control in felids (cats). Specific objectives are to investigate the mechanisms regulating ovarian activity, develop effective protocols for ovarian inhibition, and to apply these protocols to improve ovarian response to gonadotropin stimulation for AI and IVF. This, in turn, will help propagate cats valuable to biomedical research and conserve endangered felid species. Many rare cat populations are difficult to manage due to poor reproductive capacity, physical and behavioral obstacles to breeding success, and limitations on transporting animals between institutions. Unfortunately, females also experience low pregnancy success after Al and IVF due, in part, to high variability in ovarian response to exogenous gonadotropins. Controlling the ovary prior to ovulation induction improves pregnancy success in some species, but this concept has not been tested in an induced ovulator such as the cat. This project will combine basic and applied research to characterize the female response to four ovarian cycle inhibitors: 1) leuprolide acetate (Lupron), a gonadotropin releasing hormone (GnRH) agonist; 2) Antide, a GnRH antagonist; 3) levonorgestrel (Norplant), a progestogen implant; and 4) altrenogest (Regumate), an oral progestogen. The impact of ovarian cycle inhibition prior to gonadotropin stimulation will be examined at three sites: 1) the ovary during hormonal therapy, 2) the follicle and oocyte after gonadotropin stimulation, and 3) the uterus after ovulation induction and AI. Findings will be applied to rare felid models used in biomedical research and selected rare felid species to enhance propagation success. This research program is designed to provide a multidisciplinary, integrative training opportunity that will allow the candidate to advance as a reproductive physiologist with expertise in endocrinology, immunoassay development, noninvasive hormone monitoring, gamete metabolism, laparoscopy, AI, IVF, immunohistochemistry, reverse transcriptase polymerase chain reaction (RT-PCR) and histology. Research benefits include: 1) understanding mechanisms for controlling ovarian function in felids, 2) characterizing the impact of ovarian cycle inhibition prior to exogenous gonadotropin stimulation, 3) developing a research strategy for investigating complex mechanisms of female infertility, and 4) enhancing the efficiency of feline model propagation to ensure continued availability of cats for biomedical research and species conservation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Levonorgestrel

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “levonorgestrel” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for levonorgestrel in the PubMed Central database: •

Apparent interaction between warfarin and levonorgestrel used for emergency contraception. by Ellison J, Thomson AJ, Greer IA, Walker ID.; 2000 Dec 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27541

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Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. by Lahteenmaki P, Haukkamaa M, Puolakka J, Riikonen U, Sainio S, Suvisaari J, Nilsson CG.; 1998 Apr 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28513

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Risk of venous thromboembolism among users of third generation oral contraceptives compared with users of oral contraceptives with levonorgestrel before and after 1995: cohort and case-control analysis. by Jick H, Kaye JA, VasilakisScaramozza C, Jick SS.; 2000 Nov 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27524

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with levonorgestrel, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “levonorgestrel” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for levonorgestrel (hyperlinks lead to article summaries):

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A 3-year double-blind, randomized, controlled study on the influence of two oral contraceptives containing either 20 microg or 30 microg ethinylestradiol in combination with levonorgestrel on bone mineral density. Author(s): Endrikat J, Mih E, Dusterberg B, Land K, Gerlinger C, Schmidt W, Felsenberg D. Source: Contraception. 2004 March; 69(3): 179-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14969664

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A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy. Author(s): Varila E, Wahlstrom T, Rauramo I. Source: Fertility and Sterility. 2001 November; 76(5): 969-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11704119

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A comparative study of the effects of an estradiol-releasing vaginal ring combined with an oral gestagen versus transdermal estrogen combined with a levonorgestrelreleasing IUD: clinical findings and endometrial response. Author(s): Kalogirou D, Antoniou G, Karakitsos P, Kalogirou O, Antoniou D, Giannikos L. Source: Int J Fertil Menopausal Stud. 1996 November-December; 41(6): 522-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9010746

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A comparative study of two levonorgestrel-containing hormone replacement therapy regimens of efficacy and tolerability variables. Author(s): Graser T, Rossner P, Schubert K, Muller A, Bonisch U, Oettel M. Source: Maturitas. 1997 December 15; 28(2): 169-79. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9522325

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A comparison of cycle control with monophasic levonorgestrel/ethinylestradiol 100 micrograms/20 micrograms versus triphasic norethindrone/ethinylestradiol 500-7501000 micrograms/35 micrograms: a multicenter, randomized, open-label study. Author(s): Chavez A, DelConte A. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1999 June; 4(2): 75-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10427482

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A comparison of the inhibition of ovulation achieved by desogestrel 75 micrograms and levonorgestrel 30 micrograms daily. Author(s): Rice CF, Killick SR, Dieben T, Coelingh Bennink H. Source: Human Reproduction (Oxford, England). 1999 April; 14(4): 982-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10221231

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A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Author(s): Vercellini P, Aimi G, Panazza S, De Giorgi O, Pesole A, Crosignani PG. Source: Fertility and Sterility. 1999 September; 72(3): 505-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10519624

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A lower dosage levonorgestrel and testosterone combination effectively suppresses spermatogenesis and circulating gonadotropin levels with fewer metabolic effects than higher dosage combinations. Author(s): Anawalt BD, Bebb RA, Bremner WJ, Matsumoto AM. Source: Journal of Andrology. 1999 May-June; 20(3): 407-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10386821

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A multicenter randomized comparison of cycle control and laboratory findings with oral contraceptive agents containing 100 microg levonorgestrel with 20 microg ethinyl estradiol or triphasic norethindrone with ethinyl estradiol. Author(s): Reisman H, Martin D, Gast MJ. Source: American Journal of Obstetrics and Gynecology. 1999 November; 181(5 Pt 2): 4552. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10561675

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A multicenter, uncontrolled clinical investigation of the contraceptive efficacy, cycle control, and safety of a new low dose oral contraceptive containing 20 micrograms ethinyl estradiol and 100 micrograms levonorgestrel over six treatment cycles. Author(s): Bannemerschult R, Hanker JP, Wunsch C, Fox P, Albring M, Brill K. Source: Contraception. 1997 November; 56(5): 285-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9437556

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A new low-dose monophasic combination oral contraceptive (Alesse) with levonorgestrel 100 micrograms and ethinyl estradiol 20 micrograms. North American Levonorgestrel Study Group (NALSG). Author(s): Archer DF, Maheux R, DelConte A, O'Brien FB. Source: Contraception. 1997 March; 55(3): 139-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9115001

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A pharmacokinetic study with a low-dose oral contraceptive containing 20 microg ethinylestradiol plus 100 microg levonorgestrel. Author(s): Endrikat J, Blode H, Gerlinger C, Rosenbaum P, Kuhnz W. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2002 June; 7(2): 79-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12201326

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A pilot study on the acceptability of levonorgestrel-releasing intrauterine device by young, single, nulliparous Chinese females following surgical abortion. Author(s): Li CF, Lee SS, Pun TC. Source: Contraception. 2004 March; 69(3): 247-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14969674

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A prospective study of insulin sensitivity and glucose metabolism in women using a continuous subdermal levonorgestrel implant system. Author(s): Harper MA, Meis PJ, Steele L. Source: Journal of the Society for Gynecologic Investigation. 1997 March-April; 4(2): 869. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9101467

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A qualitative study of perceptions, attitudes, and experiences of long-term levonorgestrel implant users. Author(s): Sangi-Haghpeykar H, Frank ML, Leonard L, Poindexter AN. Source: Women & Health. 2000; 30(4): 93-108. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10983612

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A randomized controlled double-blind study of the effects on hemostasis of two progestogen-only pills containing 75 microgram desogestrel or 30 microgram levonorgestrel. Author(s): Winkler UH, Howie H, Buhler K, Korver T, Geurts TB, Coelingh Bennink HJ. Source: Contraception. 1998 June; 57(6): 385-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9693398

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A randomized controlled trial of levonorgestrel releasing IUD and thermal balloon ablation in the treatment of menorrhagia. Author(s): Soysal M, Soysal S, Ozer S. Source: Zentralblatt Fur Gynakologie. 2002 April; 124(4): 213-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12080483

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A randomized cross-over study on the effects of levonorgestrel- and desogestrelcontaining oral contraceptives on the anticoagulant pathways. Author(s): Tans G, Curvers J, Middeldorp S, Thomassen MC, Meijers JC, Prins MH, Bouma BN, Buller HR, Rosing J. Source: Thrombosis and Haemostasis. 2000 July; 84(1): 15-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10928463

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A randomized, controlled trial of a low-dose contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for acne treatment. Author(s): Thiboutot D, Archer DF, Lemay A, Washenik K, Roberts J, Harrison DD. Source: Fertility and Sterility. 2001 September; 76(3): 461-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11532465

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A retrospective cohort study comparing microwave endometrial ablation with levonorgestrel-releasing intrauterine device in the management of heavy menstrual bleeding. Author(s): Henshaw R, Coyle C, Low S, Barry C. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 May; 42(2): 205-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12069151

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A risk-benefit assessment of the levonorgestrel-releasing intrauterine system. Author(s): Sturridge F, Guillebaud J. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 1996 December; 15(6): 430-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8968696

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Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil. Author(s): Diaz J, Bahamondes L, Monteiro I, Petta C, Hildalgo MM, Arce XE. Source: Contraception. 2000 August; 62(2): 59-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11102588

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Acceptability of the levonorgestrel-releasing intrauterine system after discontinuation of previous contraception: results of a French clinical study in women aged 35 to 45 years. Author(s): Dubuisson JB, Mugnier E. Source: Contraception. 2002 August; 66(2): 121-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12204786

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Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Author(s): Baldaszti E, Wimmer-Puchinger B, Loschke K. Source: Contraception. 2003 February; 67(2): 87-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12586318

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Adolescents' attitudes and experiences regarding levonorgestrel 100 mcg/ethinyl estradiol 20 mcg. Author(s): Rosenthal SL, Cotton S, Ready JN, Potter LS, Succop PA. Source: Journal of Pediatric and Adolescent Gynecology. 2002 December; 15(5): 301-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12547661

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Advance information improves user satisfaction with the levonorgestrel intrauterine system. Author(s): Backman T, Huhtala S, Luoto R, Tuominen J, Rauramo I, Koskenvuo M. Source: Obstetrics and Gynecology. 2002 April; 99(4): 608-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12039121

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Amenorrhoea despite displaced levonorgestrel intra-uterine system. Author(s): Bobrow C, Cooling H, Bisson D. Source: Br J Fam Plann. 2000 April; 26(2): 105-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10773605

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An open label, comparative study of the effects of a dose-reduced oral contraceptive containing 20 microg ethinyl estradiol and 100 microg levonorgestrel on hemostatic, lipids, and carbohydrate metabolism variables. Author(s): Endrikat J, Klipping C, Cronin M, Gerlinger C, Ruebig A, Schmidt W, Dusterberg B. Source: Contraception. 2002 March; 65(3): 215-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11929643

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Assessment of the oestrogenic activity of the contraceptive progestin levonorgestrel and its non-phenolic metabolites. Author(s): Santillan R, Perez-Palacios G, Reyes M, Damian-Matsumura P, Garcia GA, Grillasca I, Lemus AE. Source: European Journal of Pharmacology. 2001 September 14; 427(2): 167-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11557270

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Attitudes and experiences with levonorgestrel 100 microg/ethinyl estradiol 20 microg among women during a 3-month trial. Author(s): Wimberly YH, Cotton S, Wanchick AM, Succop PA, Rosenthal SL. Source: Contraception. 2002 June; 65(6): 403-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12127637

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Bcl-2, Fas and caspase 3 expression in endometrium from levonorgestrel implant users with and without breakthrough bleeding. Author(s): Rogers PA, Lederman F, Plunkett D, Affandi B. Source: Human Reproduction (Oxford, England). 2000 August; 15 Suppl 3: 152-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041231

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Binding of levonorgestrel, norethisterone and desogestrel to human sex hormone binding globulin and influence on free testosterone levels. Author(s): Nilsson B, von Schoultz B. Source: Gynecologic and Obstetric Investigation. 1989; 27(3): 151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2525511

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Binding of the gestagens norethisterone and levonorgestrel in blood of various species. Author(s): Jenkins N, Fotherby K. Source: J Steroid Biochem. 1981 October; 14(10): 1055-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6795390

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Bioavailability of levonorgestrel from intravaginal rings in women of low income groups. Author(s): Madhavan Nair K, Sivakumar B, Prema K, Narasinga Rao BS. Source: Contraception. 1986 March; 33(3): 307-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3087697

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Bioavailability study with 2 different levonorgestrel-containing drugs in women. Author(s): Nassr N, Farker K, Lautenschlager M, Nagel U, Zimmermann H, Mellinger U, Hoffmann A. Source: Int J Clin Pharmacol Ther. 1997 March; 35(3): 123-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9089002

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Bleeding and ovulation control with use of a small contraceptive vaginal ring releasing levonorgestrel and estradiol. Author(s): Toivonen J, Lahteenmaki P, Luukkainen T. Source: Contraception. 1979 July; 20(1): 11-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=477313

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Bleeding pattern, outcome of accidental pregnancies and levonorgestrel plasma levels associated with method failure in Norplant implants users. Author(s): Diaz S, Pavez M, Herreros C, Johansson ED, Croxatto HB. Source: Contraception. 1986 April; 33(4): 347-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3089680

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Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Author(s): Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C. Source: Contraception. 2002 February; 65(2): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11927115

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Blood levels of levonorgestrel in women following vaginal placement of contraceptive pills. Author(s): Alvarez F, Faundes A, Johansson E, Coutinho E. Source: Fertility and Sterility. 1983 July; 40(1): 120-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6407876

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Body iron stores and patterns of bleeding after insertion of a levonorgestrel- or a copper-releasing intrauterine contraceptive device. Author(s): Heikkila M, Nylander P, Luukkainen T. Source: Contraception. 1982 November; 26(5): 465-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6819112

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Can the levonorgestrel intrauterine system replace surgical treatment for the management of menorrhagia? Author(s): Nagrani R, Bowen-Simpkins P, Barrington JW. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 March; 109(3): 345-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950191

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Cervical cytology associated with levonorgestrel contraception. Author(s): Misra JS, Engineer AD, Tandon P. Source: Acta Cytol. 1995 January-February; 39(1): 45-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7847008

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Changes in psychic and somatic well-being and cognitive capabilities of peri- and postmenopausal women after the use of a hormone replacement drug containing estradiol valerate and levonorgestrel. Author(s): Rudolph I, Zimmermann T, Kaminski K, Jandova K, Borovsky B, Ahrendt HJ, Golbs S. Source: Methods Find Exp Clin Pharmacol. 2000 January-February; 22(1): 51-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10791296

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Circulating sex hormones and endometrial stromelysin-1 (matrix metalloproteinase-3) at the start of bleeding episodes in levonorgestrel-implant users. Author(s): Marbaix E, Vekemans M, Galant C, Rigot V, Lemoine P, Dubois D, Picquet C, Henriet P, Twagirayezu P, Sufi S, Eeckhout Y, Courtoy PJ. Source: Human Reproduction (Oxford, England). 2000 August; 15 Suppl 3: 120-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041228

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Levonorgestrel

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Clinical comparative study of oral contraceptives containing 30 microg ethinylestradiol/150 microg levonorgestrel, and 35 microg ethinylestradiol/250 microg norgestimate in Thai women. Author(s): Tantbirojn P, Taneepanichskul S. Source: Contraception. 2002 December; 66(6): 401-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499031

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Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. Author(s): Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivela A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Source: Jama : the Journal of the American Medical Association. 2004 March 24; 291(12): 1456-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15039412

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Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study. Author(s): Suhonen S, Haukkamaa M, Jakobsson T, Rauramo I. Source: Contraception. 2004 May; 69(5): 407-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15105064

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Clinical performance of a new two-rod levonorgestrel contraceptive implant: a threeyear randomized study with Norplant implants as controls. Author(s): Sivin I, Viegas O, Campodonico I, Diaz S, Pavez M, Wan L, Koetsawang S, Kiriwat O, Anant MP, Holma P, el din Abdalla K, Stern J. Source: Contraception. 1997 February; 55(2): 73-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9071515

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Clinical performance of the levonorgestrel intra-uterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report. Author(s): Cox M, Blacksell S. Source: Br J Fam Plann. 2000 July; 26(3): 143-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10920290

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Clinical performance of the levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report. Author(s): Cox M, Tripp J, Blacksell S. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2002 April; 28(2): 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12396776

Studies

21

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Clinical trial of transdermal testosterone and oral levonorgestrel for male contraception. Author(s): Buchter D, von Eckardstein S, von Eckardstein A, Kamischke A, Simoni M, Behre HM, Nieschlag E. Source: The Journal of Clinical Endocrinology and Metabolism. 1999 April; 84(4): 1244-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10199762

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Combination of subcutaneous levonorgestrel implants and transdermal dihydrotestosterone gel for male hormonal contraception. Author(s): Pollanen P, Nikkanen V, Huhtaniemi I. Source: International Journal of Andrology. 2001 December; 24(6): 369-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11737418

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Combined administration of levonorgestrel and testosterone induces more rapid and effective suppression of spermatogenesis than testosterone alone: a promising male contraceptive approach. Author(s): Bebb RA, Anawalt BD, Christensen RB, Paulsen CA, Bremner WJ, Matsumoto AM. Source: The Journal of Clinical Endocrinology and Metabolism. 1996 February; 81(2): 757-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8636300

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Combined oral contraceptives versus levonorgestrel for emergency contraception. Author(s): Strayer SM, Couchenour RL. Source: The Journal of Family Practice. 1998 December; 47(6): 417. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9866661

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Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians. Author(s): Arowojolu AO, Okewole IA, Adekunle AO. Source: Contraception. 2002 October; 66(4): 269-73. Erratum In: Contraception. 2003 February; 67(2): 165. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12413624

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Comparative progestational activity of norgestimate, levonorgestrel-oxime and levonorgestrel in the rat and binding of these compounds to the progesterone receptor. Author(s): Kuhnz W, Fritzemeier KH, Hegele-Hartung C, Krattenmacher R. Source: Contraception. 1995 February; 51(2): 131-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7750291

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Levonorgestrel

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Comparison between the levonorgestrel intrauterine system (LNG-IUS) and thermal balloon ablation in the treatment of menorrhagia. Author(s): Barrington JW, Arunkalaivanan AS, Abdel-Fattah M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 May 1; 108(1): 72-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694974

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Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Author(s): Vercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani PG. Source: Fertility and Sterility. 2003 August; 80(2): 305-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909492

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Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethinyl estradiol. Author(s): Bjarnadottir RI, Tuppurainen M, Killick SR. Source: American Journal of Obstetrics and Gynecology. 2002 March; 186(3): 389-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11904596

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Comparison of ovarian cyst formation in women using the levonorgestrel-releasing intrauterine system vs. hysterectomy. Author(s): Inki P, Hurskainen R, Palo P, Ekholm E, Grenman S, Kivela A, Kujansuu E, Teperi J, Yliskoski M, Paavonen J. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 October; 20(4): 381-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12383322

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Comparison of the effects of triphasic oral contraceptives with desogestrel or levonorgestrel on apolipoprotein A-I-containing high-density lipoprotein particles. Author(s): Cheung MC, Walden CE, Knopp RH. Source: Metabolism: Clinical and Experimental. 1999 May; 48(5): 658-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10337871

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Comparison of the lipoprotein, carbohydrate, and hemostatic effects of phasic oral contraceptives containing desogestrel or levonorgestrel. Author(s): Knopp RH, Broyles FE, Cheung M, Moore K, Marcovina S, Chandler WL. Source: Contraception. 2001 January; 63(1): 1-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11257242

Studies

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Continuation rates with a levonorgestrel-releasing contraceptive implant (Norplant). A prospective study in Belgium. Author(s): Vekemans M, Delvigne A, Paesmans M. Source: Contraception. 1997 November; 56(5): 291-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9437557

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Contraception and treatment in the perimenopause with a novel "frameless" intrauterine levonorgestrel-releasing drug delivery system: an extended pilot study. Author(s): Wildemeersch D, Schacht E, Wildemeersch P. Source: Contraception. 2002 August; 66(2): 93-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12204781

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Contraception with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study. Author(s): Wildemeersch D, Schacht E. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2000 December; 5(4): 234-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11245550

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Contraception with two levonorgestrel rod implants. A 5-year study in the United States and Dominican Republic. Author(s): Sivin I, Alvarez F, Mishell DR Jr, Darney P, Wan L, Brache V, Lacarra M, Klaisle C, Stern J. Source: Contraception. 1998 November; 58(5): 275-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9883382

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Correlates and consequences of early removal of levonorgestrel implants among teenaged mothers. Author(s): Stevens-Simon C, Kelly L. Source: Archives of Pediatrics & Adolescent Medicine. 1998 September; 152(9): 893-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9743036

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Cost-effectiveness of levonorgestrel subdermal implants. Comparison with other contraceptive methods available in the United States. Author(s): Ashraf T, Arnold SB, Maxfield M Jr. Source: J Reprod Med. 1994 October; 39(10): 791-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7837126

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Levonorgestrel

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Cycle control with oral contraceptives containing 20 micrograms of ethinyl estradiol. A multicenter, randomized comparison of levonorgestrel/ethinyl estradiol (100 micrograms/20 micrograms) and norethindrone/ethinyl estradiol (1000 micrograms/20 micrograms). Author(s): DelConte A, Loffer F, Grubb GS. Source: Contraception. 1999 March; 59(3): 187-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10382082

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Cyproterone, norethindrone, medroxyprogesterone and levonorgestrel are less potent local human growth hormone and insulin-like growth factor I secretion stimulators than progesterone in human breast cancer explants expressing the estrogen receptor. Author(s): Milewicz T, Kolodziejczyk J, Krzysiek J, Basta A, Sztefko K, Kurek S, Stachura J, Gregoraszczuk EL. Source: Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology. 2002 August; 16(4): 319-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12396561

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Data support extended use of levonorgestrel intrauterine systems. Author(s): Mansour D, Guillebaud J. Source: Bmj (Clinical Research Ed.). 1998 May 30; 316(7145): 1671. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9603759

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Depot levonorgestrel (Norplant) use in teenagers. Author(s): Miller M. Source: The Western Journal of Medicine. 1993 February; 158(2): 183. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8434476

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Depot medroxyprogesterone acetate (Depo-Provera) and levonorgestrel (Norplant) use in adolescents among clinicians in Northern Europe and the United States. Author(s): Cromer BA, Berg-Kelly KS, Van Groningen JP, Seimer BS, Ruusuvaara L. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 August; 23(2): 74-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9714169

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Desogestrel- and levonorgestrel-containing oral contraceptives have different effects on urinary excretion of prostacyclin metabolites and serum high density lipoproteins. Author(s): Ylikorkala O, Kuusi T, Tikkanen MJ, Viinikka L. Source: The Journal of Clinical Endocrinology and Metabolism. 1987 December; 65(6): 1238-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2960690

Studies

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Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system. Author(s): Suvisaari J, Lahteenmaki P. Source: Contraception. 1996 October; 54(4): 201-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8922872

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Development of a miniature, low-dose, frameless intrauterine levonorgestrelreleasing system for contraception and treatment: a review of initial clinical experience. Author(s): Wildemeersch D, Schacht E, Wildemeersch P, Janssens D, Thiery M. Source: Reproductive Biomedicine Online. 2002 January-February; 4(1): 71-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12470357

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Development of the ratio of levonorgestrel, 0.15 mg, to ethinyl estradiol, 0.03 mg. Author(s): Christie T. Source: J Reprod Med. 1983 January; 28(1 Suppl): 63-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6403701

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Different effects of oral contraceptives containing levonorgestrel or desogestrel on plasma lipoproteins and coagulation factor VII. Author(s): van Rooijen M, von Schoultz B, Silveira A, Hamsten A, Bremme K. Source: American Journal of Obstetrics and Gynecology. 2002 January; 186(1): 44-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11810082

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Does endogenous sex hormone binding globulin influence the contraceptive effect of levonorgestrel? Author(s): Cekan SZ. Source: Steroids. 1988 October; 52(4): 399-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3150627

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Double-blind, randomized study comparing the effects of two monophasic oral contraceptives containing ethinylestradiol (20 microg or 30 microg) and levonorgestrel (100 microg or 150 microg) on lipoprotein metabolism. Author(s): Scharnagl H, Petersen G, Nauck M, Teichmann AT, Wieland H, Marz W. Source: Contraception. 2004 February; 69(2): 105-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14759614

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Drug Points: Apparent interaction between warfarin and levonorgestrel used for emergency contraception. Author(s): Ellison J, Thomson AJ, Greer IA, Walker ID. Source: Bmj (Clinical Research Ed.). 2000 December 2; 321(7273): 1382. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11099283

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Levonorgestrel

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Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device. Author(s): Heikkila M, Luukkainen T. Source: Contraception. 1982 March; 25(3): 279-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6804164

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Ectopic gestation following emergency contraception with levonorgestrel. Author(s): Jian Z, Linan C. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2003 December; 8(4): 225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006270

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Ectopic pregnancies following emergency levonorgestrel contraception. Author(s): Sheffer-Mimouni G, Pauzner D, Maslovitch S, Lessing JB, Gamzu R. Source: Contraception. 2003 April; 67(4): 267-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684145

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Ectopic pregnancy in the levonorgestrel releasing intrauterinesystem (LNG-IUS) user: atypical presentation. Author(s): Abu JI, Wandless GM, Emembolu JO. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 567-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12521443

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Effect of concomitant hormone replacement therapy containing estradiol and levonorgestrel on the pharmacokinetics of selegiline. Author(s): Palovaara S, Anttila M, Nyman L, Laine K. Source: European Journal of Clinical Pharmacology. 2002 July; 58(4): 259-63. Epub 2002 May 22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12136372

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Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. Author(s): Marions L, Cekan SZ, Bygdeman M, Gemzell-Danielsson K. Source: Contraception. 2004 May; 69(5): 373-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15105059

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Effect of mifepristone and levonorgestrel on expression of steroid receptors in the human Fallopian tube. Author(s): Christow A, Sun X, Gemzell-Danielsson K. Source: Molecular Human Reproduction. 2002 April; 8(4): 333-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11912281

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Effect of two oral contraceptives containing ethinylestradiol and levonorgestrel on serum and urinary surrogate markers of endothelial function. Author(s): Seeger H, Petersen G, Schulte-Wintrop E, Teichmann AT, Mueck AO. Source: Int J Clin Pharmacol Ther. 2002 April; 40(4): 150-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11996209

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Effect of two oral contraceptives with different ethinyl estradiol and levonorgestrel concentrations on the urinary excretion of biochemical vasoactive markers. Author(s): Mueck AO, Seeger H, Petersen G, Schulte-Wintrop E, Wallwiener D. Source: Contraception. 2001 December; 64(6): 357-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11834234

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Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation. Author(s): Bassol S, Nava-Hernandez MP, Hernandez-Morales C, Trujillo-Macias AM, Lopez-Lozano MR, Recio R. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 March; 76(3): 273-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11880130

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Effects of levonorgestrel, medroxyprogesterone acetate, norethindrone, progesterone, and 17beta-estradiol on thrombospondin-1 mRNA in Ishikawa cells. Author(s): Mirkin S, Archer DF. Source: Fertility and Sterility. 2004 July; 82(1): 220-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15237017

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Effects of levonorgestrel-releasing intra-uterine system on the expression of vascular endothelial growth factor and adrenomedullin in the endometrium in adenomyosis. Author(s): Laoag-Fernandez JB, Maruo T, Pakarinen P, Spitz IM, Johansson E. Source: Human Reproduction (Oxford, England). 2003 April; 18(4): 694-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12660258

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Effects of the combined hormonal replacement drug estradiol valerate/levonorgestrel on climacteric complaints, endometrium and lipid profile of peri- and postmenopausal women. Author(s): Georgiev DB, Golbs S, Goudev A. Source: Methods Find Exp Clin Pharmacol. 2001 May; 23(4): 197-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11676228

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Levonorgestrel

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Effects of the levonorgestrel-releasing intrauterine system on proliferation and apoptosis in the endometrium. Author(s): Maruo T, Laoag-Fernandez JB, Pakarinen P, Murakoshi H, Spitz IM, Johansson E. Source: Human Reproduction (Oxford, England). 2001 October; 16(10): 2103-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11574499

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Effects of two low-dose oral contraceptives containing ethinylestradiol and either desogestrel or levonorgestrel on serum lipids and lipoproteins with particular regard to LDL size. Author(s): Foulon T, Payen N, Laporte F, Bijaoui S, Dupont G, Roland F, Groslambert P. Source: Contraception. 2001 July; 64(1): 11-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535207

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Effects on coagulation of levonorgestrel- and desogestrel-containing low dose oral contraceptives: a cross-over study. Author(s): Middeldorp S, Meijers JC, van den Ende AE, van Enk A, Bouma BN, Tans G, Rosing J, Prins MH, Buller HR. Source: Thrombosis and Haemostasis. 2000 July; 84(1): 4-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10928461

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Efficacy and safety of oral and transdermal hormonal replacement treatment containing levonorgestrel. Author(s): Paoletti AM, Pilloni M, Orru M, Floris S, Pistis M, Guerriero S, Ajossa S, Melis GB. Source: Maturitas. 2002 June 25; 42(2): 137-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12065173

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Efficacy of a low-dose oral contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for the treatment of moderate acne: A randomized, placebo-controlled trial. Author(s): Leyden J, Shalita A, Hordinsky M, Swinyer L, Stanczyk FZ, Weber ME. Source: Journal of the American Academy of Dermatology. 2002 September; 47(3): 399409. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12196750

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Efficacy of a new 7-day transdermal sequential estradiol/levonorgestrel patch in women. Author(s): von Holst T, Salbach B. Source: Maturitas. 2002 March 25; 41(3): 231-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11886769

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Efficacy of the levonorgestrel intrauterine system in treating menorrhagia: actualities and ambiguities. Author(s): Ikomi A, Pepra EF. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2002 April; 28(2): 99-100. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12396783

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Emergency contraception with levonorgestrel: one hormone better than two. Author(s): O'Brien PA. Source: Br J Fam Plann. 2000 April; 26(2): 67-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10773597

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Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Author(s): Marions L, Hultenby K, Lindell I, Sun X, Stabi B, Gemzell Danielsson K. Source: Obstetrics and Gynecology. 2002 July; 100(1): 65-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12100805

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Endometrial expression of glycodelin in women with levonorgestrel-releasing subdermal implants. Author(s): Mandelin E, Koistinen H, Koistinen R, Arola J, Affandi B, Seppala M. Source: Fertility and Sterility. 2001 September; 76(3): 474-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11532467

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Endometrial polyp and the levonorgestrel intrauterine system--a case report and literature review. Author(s): Sinha A, Nwosu EC. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 695. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12554277

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Endometrial protection from tamoxifen-stimulated changes by a levonorgestrelreleasing intrauterine system: a randomised controlled trial. Author(s): Gardner FJ, Konje JC, Abrams KR, Brown LJ, Khanna S, Al-Azzawi F, Bell SC, Taylor DJ. Source: Lancet. 2000 November 18; 356(9243): 1711-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11095258

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Endometrial safety of a transdermal sequential estradiol-levonorgestrel combination. Author(s): Sturdee DW, van de Weijer P, von Holst T. Source: Climacteric : the Journal of the International Menopause Society. 2002 June; 5(2): 170-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12051113

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Endometrial suppression with a new 'frameless' levonorgestrel releasing intrauterine system in perimenopausal and postmenopausal women: a pilot study. Author(s): Wildemeersch D, Schacht E. Source: Maturitas. 2000 July 31; 36(1): 63-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10989243

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Estradiol and levonorgestrel: effects on bleeding pattern when administered in a sequential combined regimen with a new transdermal patch. Author(s): van de Weijer PH, Sturdee DW, von Holst T. Source: Climacteric : the Journal of the International Menopause Society. 2002 March; 5(1): 36-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11974558

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Exacerbation of Crohn's disease after insertion of a levonorgestrel intrauterine system: a case report. Author(s): Wakeman J. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2003 July; 29(3): 154. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885311

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Expression of matrix metalloproteinase-26 and tissue inhibitor of matrix metalloproteinase-3 and -4 in endometrium throughout the normal menstrual cycle and alteration in users of levonorgestrel implants who experience irregular uterine bleeding. Author(s): Chegini N, Rhoton-Vlasak A, Williams RS. Source: Fertility and Sterility. 2003 September; 80(3): 564-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12969699

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Expression of sex steroid receptors and Ki-67 in the endometria of menorrhagic women: effects of intrauterine levonorgestrel. Author(s): Hurskainen R, Salmi A, Paavonen J, Teperi J, Rutanen E. Source: Molecular Human Reproduction. 2000 November; 6(11): 1013-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11044464

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Failed cervical pregnancy with levonorgestrel containing intrauterine contraceptive device. Author(s): Trivedi AN, Ngu A. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 May; 42(2): 210-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12069152

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Fertility after discontinuation of levonorgestrel-releasing intrauterine devices. Author(s): Nilsson CG. Source: Contraception. 1982 March; 25(3): 273-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6804163

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Fertility regulation in nursing women: VII. Influence of NORPLANT levonorgestrel implants upon lactation and infant growth. Author(s): Diaz S, Herreros C, Juez G, Casado ME, Salvatierra AM, Miranda P, Peralta O, Croxatto HB. Source: Contraception. 1985 July; 32(1): 53-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3931973

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Fertility regulation using "triphasic" administration of ethinyl estradiol and levonorgestrel in comparison with the 30 plus 150 micrograms fixed dose regime. Author(s): Zador G. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1979; 88: 43-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=393049

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FFPRHC Guidance (April 2004). The levonorgestrel-releasing intrauterine system (LNG-IUS) in contraception and reproductive health. Author(s): Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2004 April; 30(2): 99-108; Quiz 109. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15086994

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Fibrosis attached to the tail of a levonorgestrel intra-uterine system. Author(s): Ortayli N, Say L. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2001 July; 27(3): 177, 179. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12463228

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First week drug concentrations in women with levonorgestrel rod or Norplant capsule implants. Author(s): Sivin I, Lahteenmaki P, Mishell DR Jr, Alvarez F, Diaz S, Ranta S, Grozinger C, Lacarra M, Brache V, Pavez M, Nash H, Stern J. Source: Contraception. 1997 November; 56(5): 317-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9437561

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First year clinical experience with six levonorgestrel rods as subdermal contraception. Author(s): Faundes A, Brache de Mejias V, Leon P, Robertson D, Alvarez F. Source: Contraception. 1979 August; 20(2): 167-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=487818

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Five years' experience with levonorgestrel-releasing IUDs. Author(s): Luukkainen T, Allonen H, Haukkamaa M, Lahteenmaki P, Nilsson CG, Toivonen J. Source: Contraception. 1986 February; 33(2): 139-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3084167

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Free levonorgestrel index and its relationship with luteal activity during long-term use of Norplant implants. Author(s): Brache V, Alvarez-Sanchez F, Faundes A, Tejada AS, Cochon L. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1992 December; 8(4): 319-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1365818

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Gynaecological aspects of the levonorgestrel-releasing intrauterine system. Author(s): Sturridge F, Guillebaud J. Source: British Journal of Obstetrics and Gynaecology. 1997 March; 104(3): 285-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9091003

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GyneFix-LNG: preliminary clinical experience with a copper and levonorgestrelreleasing intrauterine system. Author(s): Wildemeersch D, Dhont M, Temmerman M, Delbarge W, Schacht E, Thiery M. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1999 March; 4(1): 15-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10367191

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Health during prolonged use of levonorgestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices: a multicenter study. International Committee for Contraception Research (ICCR). Author(s): Sivin I, Stern J. Source: Fertility and Sterility. 1994 January; 61(1): 70-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8293847

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Health effects of long-term use of the intrauterine levonorgestrel-releasing system. A follow-up study over 12 years of continuous use. Author(s): Ronnerdag M, Odlind V. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 September; 78(8): 716-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10468065

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Hemostatic system changes induced by 50 micrograms and 30 micrograms estrogen/progestogen oral contraceptives. Modification of estrogen effects by levonorgestrel. Author(s): Sabra A, Bonnar J. Source: J Reprod Med. 1983 January; 28(1 Suppl): 85-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6834350

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Hormonal contraception in Chinese men: variations in suppression of spermatogenesis with injectable testosterone undecanoate and levonorgestrel implants. Author(s): Liu ST, Gui YL, Lin CH, He CH. Source: Asian Journal of Andrology. 2004 March; 6(1): 41-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15064833

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Hormonally mediated disturbance of angiogenesis in the human endometrium after exposure to intrauterine levonorgestrel. Author(s): McGavigan CJ, Dockery P, Metaxa-Mariatou V, Campbell D, Stewart CJ, Cameron IT, Campbell S. Source: Human Reproduction (Oxford, England). 2003 January; 18(1): 77-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12525444

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Hyperglycaemic episodes in a young woman after taking levonorgestrel-containing oral contraceptives. Author(s): Rennie NJ. Source: N Z Med J. 1994 October 26; 107(988): 440-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7970351

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Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods. Author(s): Ortayli N, Bulut A, Sahin T, Sivin I. Source: Contraception. 2001 June; 63(6): 309-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11672552

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Immunohistochemical detection of cathepsin D in endometrium from long-term subdermal levonorgestrel users and during the normal menstrual cycle. Author(s): Lau TM, Affandi B, Rogers PA. Source: Molecular Human Reproduction. 1996 April; 2(4): 233-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9238685

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Impact of patient counseling on acceptance of the levonorgestrel implant contraceptive in the United Kingdom. Author(s): Davie JE, Walling MR, Mansour DJ, Bromham D, Kishen M, Fowler P. Source: Clinical Therapeutics. 1996 January-February; 18(1): 150-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8851460

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Implantable levonorgestrel contraception: 4 years of experience with Norplant. Author(s): Hatasaka H. Source: Clinical Obstetrics and Gynecology. 1995 December; 38(4): 859-71. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8616982

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Importance of levonorgestrel dose in oral contraceptives for effects on coagulation. Author(s): Kluft C, de Maat MP, Heinemann LA, Spannagl M, Schramm W. Source: Lancet. 1999 September 4; 354(9181): 832-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10485729

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Induction of endometrial plasminogen activator-inhibitor 1: a possible mechanism contributing to the effect of intrauterine levonorgestrel in the treatment of menorrhagia. Author(s): Rutanen E, Hurskainen R, Finne P, Nokelainen K. Source: Fertility and Sterility. 2000 May; 73(5): 1020-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10785231

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Induction of ethinylestradiol and levonorgestrel metabolism by oxcarbazepine in healthy women. Author(s): Fattore C, Cipolla G, Gatti G, Limido GL, Sturm Y, Bernasconi C, Perucca E. Source: Epilepsia. 1999 June; 40(6): 783-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10368079

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Inhibition of DNA synthesis in isolated human endometrial cells by a levonorgestrelreleasing intrauterine device. Author(s): Luo H, Zhu P, Xu R, Cheng J, Zhao X, Wang JD. Source: Anal Quant Cytol Histol. 1999 October; 21(5): 409-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10560523

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Inhibition of ovulation by an oral contraceptive containing 100 micrograms levonorgestrel in combination with 20 micrograms ethinylestradiol. Author(s): Spona J, Feichtinger W, Kindermann C, Wunsch C, Brill K. Source: Contraception. 1996 November; 54(5): 299-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8934064

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Initial UK experience of the levonorgestrel-releasing contraceptive intravaginal ring. Author(s): Sahota J, Barnes PM, Mansfield E, Bradley JL, Kirkman RJ. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1999; 15(4): 313-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11145373

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Insulin sensitivity during postmenopausal hormone replacement with transdermal estradiol and intrauterine levonorgestrel. Author(s): Raudaskoski T, Tomas C, Laatikainen T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 July; 78(6): 540-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10376866

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Insulin-like growth factors and insulin-like growth factor binding proteins in the endometrium. Effect of intrauterine levonorgestrel delivery. Author(s): Rutanen EM. Source: Human Reproduction (Oxford, England). 2000 August; 15 Suppl 3: 173-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041233

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International clinical experience with a new low-dose, monophasic oral contraceptive containing levonorgestrel 100 microg and ethinyl estradiol 20 microg. Author(s): Boerrigter PJ, Ellman H, Dolker M. Source: Clinical Therapeutics. 1999 January; 21(1): 118-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10090429

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Intracervical and fundal administration of levonorgestrel for contraception: endometrial thickness, patterns of bleeding, and persisting ovarian follicles. Author(s): Pakarinen PI, Suvisaari J, Luukkainen T, Lahteenmaki P. Source: Fertility and Sterility. 1997 July; 68(1): 59-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9207585

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Intradermal proximal field block: an innovative anesthetic technique for levonorgestrel implant removal. Author(s): Miller L, Grice J. Source: Obstetrics and Gynecology. 1998 February; 91(2): 294-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9469293

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Intramuscular testosterone undecanoate with or without oral levonorgestrel: a randomized placebo-controlled feasibility study for male contraception. Author(s): Kamischke A, Ploger D, Venherm S, von Eckardstein S, von Eckardstein A, Nieschlag E. Source: Clinical Endocrinology. 2000 July; 53(1): 43-52. Erratum In: Clin Endocrinol (Oxf) 2000 November; 53(5): 661. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10931079

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Intraperitoneal levonorgestrel-releasing intrauterine device following uterine perforation: the role of progestins in adhesion formation. Author(s): Haimov-Kochman R, Doviner V, Amsalem H, Prus D, Adoni A, Lavy Y. Source: Human Reproduction (Oxford, England). 2003 May; 18(5): 990-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12721174

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Intrauterine 10 microg and 20 microg levonorgestrel systems in postmenopausal women receiving oral oestrogen replacement therapy: clinical, endometrial and metabolic response. Author(s): Raudaskoski T, Tapanainen J, Tomas E, Luotola H, Pekonen F, Ronni-Sivula H, Timonen H, Riphagen F, Laatikainen T. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 February; 109(2): 136-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11888095

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Intrauterine administration of levonorgestrel 5 and 10 microg/24 hours in perimenopausal hormone replacement therapy. A randomized clinical study during one year. Author(s): Wollter-Svensson LO, Stadberg E, Andersson K, Mattsson LA, Odlind V, Persson I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1997 May; 76(5): 449-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9197448

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Intrauterine administration of levonorgestrel in two low doses in HRT. A randomized clinical trial during one year: effects on lipid and lipoprotein metabolism. Author(s): Wollter-Svensson LO, Stadberg E, Andersson K, Mattsson LA, Odlind V, Persson I. Source: Maturitas. 1995 November; 22(3): 199-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8746877

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Intrauterine or oral administration of levonorgestrel in combination with estradiol to perimenopausal women--effects on lipid metabolism during 12 months of treatment. Author(s): Andersson K, Stadberg E, Mattsson LA, Rybo G, Samsioe G. Source: Int J Fertil Menopausal Stud. 1996 September-October; 41(5): 476-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8934257

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Intrauterine polyps--a cause of unscheduled bleeding in women using the levonorgestrel intrauterine system: case report. Author(s): Brechin S, Cameron ST, Paterson AM, Williams AR, Critchley HO. Source: Human Reproduction (Oxford, England). 2000 March; 15(3): 650-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10686213

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Keloid formation from levonorgestrel implant (Norplant System) insertion. Author(s): Nuovo J, Sweha A. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1994 March-April; 7(2): 152-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7857393

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Large observational trial of a new low-dose oral contraceptive containing 20 micrograms ethinylestradiol and 100 micrograms levonorgestrel (Miranova) in Germany. Author(s): Hite RC, Bannemerschult R, Fox-Kuchenbecker P, Turck R, Brill K. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1999 March; 4(1): 7-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10367190

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Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users. Author(s): Backman T, Huhtala S, Blom T, Luoto R, Rauramo I, Koskenvuo M. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 March; 107(3): 335-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10740329

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Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants. Author(s): Sivin I, Wan L, Ranta S, Alvarez F, Brache V, Mishell DR Jr, Darney P, Biswas A, Diaz S, Kiriwat O, Anant MP, Klaisle C, Pavez M, Schechter J. Source: Contraception. 2001 July; 64(1): 43-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535213

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Levonorgestrel implants (Norplant II) for male contraception clinical trials: combination with transdermal and injectable testosterone. Author(s): Gonzalo IT, Swerdloff RS, Nelson AL, Clevenger B, Garcia R, Berman N, Wang C. Source: The Journal of Clinical Endocrinology and Metabolism. 2002 August; 87(8): 3562-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12161475

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Levonorgestrel IUS use in Islamic Malaysia. Author(s): Wong CY. Source: Br J Fam Plann. 2000 April; 26(2): 117. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10896464

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Levonorgestrel versus the "Yuzpe" regimen. New choices in emergency contraception. Author(s): Lee SM, Dunn S, Evans MF. Source: Can Fam Physician. 1999 March; 45: 629-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10099801

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Levonorgestrel-only emergency contraception: real-world tolerance and efficacy. Author(s): Gainer E, Mery C, Ulmann A. Source: Contraception. 2001 July; 64(1): 17-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535208

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Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives. Author(s): French RS, Cowan FM, Mansour D, Higgins JP, Robinson A, Procter T, Morris S, Guillebaud J. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 October; 107(10): 1218-25. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11028571

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Levonorgestrel-releasing (20mcg/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives. Author(s): Onyeka BA. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 July; 108(7): 770-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11467711

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Levonorgestrel-releasing intrauterine device for the treatment of menometrorrhagia in a woman on hemodialysis. Author(s): Fedele L, Gammaro L, Bianchi S. Source: The New England Journal of Medicine. 1999 August 12; 341(7): 541. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10447446

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Levonorgestrel-releasing intrauterine devices. Author(s): Gerber B, Reimer T, Krause A, Friese K, Muller H. Source: Lancet. 2001 March 10; 357(9258): 801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11253991

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Levonorgestrel-releasing intrauterine devices. Author(s): Cohen I. Source: Lancet. 2001 March 10; 357(9258): 801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11253990

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Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Author(s): Bahamondes L, Ribeiro-Huguet P, de Andrade KC, Leon-Martins O, Petta CA. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 June; 82(6): 580-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780432

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Levonorgestrel-releasing intrauterine system for menstrual dysfunction: patient satisfaction in the district general hospital setting. Author(s): Macnab JL, Lowles IE. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 July; 22(4): 402-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12521465

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Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: predictors of outcome. Author(s): Hurskainen R, Teperi J, Aalto AM, Grenman S, Kivela A, Kujansuu E, Vuorma S, Yliskoski M, Rissanen P, Paavonen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2004 April; 83(4): 401-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15005790

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Levonorgestrel-releasing IUD and breast cancer. Author(s): Spira RM, Peretz T, Hochner-Tzelniker D, Freund HR. Source: Isr Med Assoc J. 2001 September; 3(9): 711. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11574996

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Libido, sexuality and the levonorgestrel IUS in Malaysia. Author(s): Wong CY. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2001 January; 27(1): 56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12457552

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Local levonorgestrel to prevent tamoxifen-related endometrial lesions. Author(s): Neven P. Source: Lancet. 2000 November 18; 356(9243): 1698-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11095251

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Lost levonorgestrel IUD: diagnosis and therapy. Author(s): Nitke S, Rabinerson D, Dekel A, Sheiner E, Kaplan B, Hackmon R. Source: Contraception. 2004 April; 69(4): 289-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15033403

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Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Author(s): von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bartfai G, Ng E, GemzellDanielsson K, Oyunbileg A, Wu S, Cheng W, Ludicke F, Pretnar-Darovec A, Kirkman R, Mittal S, Khomassuridze A, Apter D, Peregoudov A; WHO Research Group on Postovulatory Methods of Fertility Regulation. Source: Lancet. 2002 December 7; 360(9348): 1803-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12480356

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Management of a perforated levonorgestrel-medicated intrauterine device--a pharmacokinetic study: case report. Author(s): Haimov-Kochman R, Amsalem H, Adoni A, Lavy Y, Spitz IM. Source: Human Reproduction (Oxford, England). 2003 June; 18(6): 1231-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12773451

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Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrelreleasing intrauterine system. Author(s): Fong YF, Singh K. Source: Contraception. 1999 September; 60(3): 173-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10640162

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Menstrual blood loss with contraceptive subdermal levonorgestrel implants. Author(s): Nilsson CG, Holma P. Source: Fertility and Sterility. 1981 March; 35(3): 304-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6781939

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Metabolic effects of two low-dose triphasic oral contraceptives containing ethinyl estradiol and levonorgestrel or gestodene. Author(s): Lepot MR, Gaspard UJ. Source: Int J Fertil. 1987; 32 Suppl: 15-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2906343

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Metabolism of levonorgestrel, norethindrone, and structurally related contraceptive steroids. Author(s): Stanczyk FZ, Roy S. Source: Contraception. 1990 July; 42(1): 67-96. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2143719

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Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. I. Contraceptive efficacy and side effects. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation. Author(s): Koetsawang S, Ji G, Krishna U, Cuadros A, Dhall GI, Wyss R, Rodriquez la Puenta J, Andrade AT, Khan T, Kononova ES, et al. Source: Contraception. 1990 February; 41(2): 105-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107054

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Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. II. Expulsions and removals. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation. Author(s): Koetsawang S, Ji G, Krishna U, Cuadros A, Dhall GI, Wyss R, Rodriquez la Puenta J, Andrade AT, Khan T, Kononova ES, et al. Source: Contraception. 1990 February; 41(2): 125-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107055

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Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. III. The relationship between pregnancy rate and body weight. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation. Author(s): Koetsawang S, Ji G, Krishna U, Cuadros A, Dhall GI, Wyss R, Rodriquez la Puenta J, Andrade AT, Khan T, Kononova ES, et al. Source: Contraception. 1990 February; 41(2): 143-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107056

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Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. IV. Bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation. Author(s): Koetsawang S, Ji G, Krishna U, Cuadros A, Dhall GI, Wyss R, Rodriquez la Puenta J, Andrade AT, Khan T, Konova ES, et al. Source: Contraception. 1990 February; 41(2): 151-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107057

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Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Author(s): Raymond E, Taylor D, Trussell J, Steiner MJ. Source: Contraception. 2004 January; 69(1): 79-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14720626

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Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery. Author(s): Jones RL, Critchley HO. Source: Human Reproduction (Oxford, England). 2000 August; 15 Suppl 3: 162-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041232

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Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery. Author(s): Critchley HO, Wang H, Jones RL, Kelly RW, Drudy TA, Gebbie AE, Buckley CH, McNeilly AS, Glasier AF. Source: Human Reproduction (Oxford, England). 1998 May; 13(5): 1218-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647550

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Morphometric study of the human endometrium following continuous exposure to levonorgestrel released from vaginal rings during 90 days. Author(s): Johannisson E, Brosens I, Cornillie F, Elder M, White J, Sheppard B, Hourihan H, d'Arcangues C, Belsey EM. Source: Contraception. 1991 April; 43(4): 361-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1906792

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mRNA expression of insulin-like growth factor-I (IGF-I) is suppressed and those of IGF-II and IGF-binding protein-1 are constantly expressed in the endometrium during use of an intrauterine levonorgestrel system. Author(s): Rutanen EM, Salmi A, Nyman T. Source: Molecular Human Reproduction. 1997 September; 3(9): 749-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9357999

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Multicenter, comparative study of cycle control, efficacy and tolerability of two lowdose oral contraceptives containing 20 microg ethinylestradiol/100 microg levonorgestrel and 20 microg ethinylestradiol/500 microg norethisterone. Author(s): Endrikat J, Hite R, Bannemerschult R, Gerlinger C, Schmidt W. Source: Contraception. 2001 July; 64(1): 3-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535206

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Multi-centre open study of a triphasic levonorgestrel-ethinyloestradiol combined oral contraceptive ('Trinordiol'). Author(s): Butler AJ, Green A, Cohen M. Source: Current Medical Research and Opinion. 1987; 10(8): 503-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2960493

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Myasthenia gravis and levonorgestrel implant. Author(s): Brittain J, Lange LS. Source: Lancet. 1995 December 9; 346(8989): 1556. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7491061

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Neurovascular injury during removal of levonorgestrel implants. Author(s): Sarma SP, Hatcher RP. Source: American Journal of Obstetrics and Gynecology. 1995 January; 172(1 Pt 1): 120-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7847517

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Noncontraceptive applications of the levonorgestrel intrauterine system. Author(s): Jensen JT. Source: Curr Womens Health Rep. 2002 December; 2(6): 417-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12429074

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Nonmenstrual adverse events associated with subdermal contraceptive implants containing normegestrel and levonorgestrel. Author(s): Arowojolu AO, Ladipo OA. Source: Afr J Med Med Sci. 2003 March; 32(1): 27-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15030062

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NORPLANT and the levonorgestrel IUD in Chinese family planning programmes. Author(s): Xiao BL, Gu SJ, Wang SL, Zhu PD, Shi SQ. Source: Annals of Medicine. 1993 April; 25(2): 161-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8489754

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NORPLANT: levonorgestrel-releasing contraceptive implant. Author(s): Croxatto HB. Source: Annals of Medicine. 1993 April; 25(2): 155-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8489753

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Nova T 380 and levonorgestrel IUS studies. Author(s): Richardson S, Cox M. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2001 April; 27(2): 114. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12457529

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Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Author(s): Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A. Source: Gynecologic Oncology. 2003 December; 91(3): 526-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675671

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On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Author(s): Durand M, del Carmen Cravioto M, Raymond EG, Duran-Sanchez O, De la Luz Cruz-Hinojosa M, Castell-Rodriguez A, Schiavon R, Larrea F. Source: Contraception. 2001 October; 64(4): 227-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11747872

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Once a month administration of mifepristone improves bleeding patterns in women using subdermal contraceptive implants releasing levonorgestrel. Author(s): Cheng L, Zhu H, Wang A, Ren F, Chen J, Glasier A. Source: Human Reproduction (Oxford, England). 2000 September; 15(9): 1969-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10966997

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Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. Author(s): Lahteenmaki P, Haukkamaa M, Puolakka J, Riikonen U, Sainio S, Suvisaari J, Nilsson CG. Source: Bmj (Clinical Research Ed.). 1998 April 11; 316(7138): 1122-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9552948

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Outcomes of adolescents using levonorgestrel implants vs oral contraceptives or other contraceptive methods. Author(s): Dinerman LM, Wilson MD, Duggan AK, Joffe A. Source: Archives of Pediatrics & Adolescent Medicine. 1995 September; 149(9): 967-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7655600

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Ovarian function after seven years' use of a levonorgestrel IUD. Author(s): Barbosa I, Olsson SE, Odlind V, Goncalves T, Coutinho E. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1995 June; 11(2): 85-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7491859

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Ovarian function during treatment with high ratio levonorgestrel/ethinyl estradiol as oral contraceptives. Author(s): Johansson ED, Elamsson K, Elmestedt U. Source: Gynecologic and Obstetric Investigation. 1982; 14(2): 97-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6811379

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Ovarian function during use of a levonorgestrel-releasing IUD. Author(s): Barbosa I, Bakos O, Olsson SE, Odlind V, Johansson ED. Source: Contraception. 1990 July; 42(1): 51-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2117516

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Ovarian function in amenorrheic and menstruating users of a levonorgestrelreleasing intrauterine device. Author(s): Nilsson CG, Lahteenmaki PL, Luukkainen T. Source: Fertility and Sterility. 1984 January; 41(1): 52-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6420203

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Ovarian function is effectively inhibited by a low-dose triphasic oral contraceptive containing ethinylestradiol and levonorgestrel. Author(s): Gaspard UJ, Dubois M, Gillain D, Franchimont P, Duvivier J. Source: Contraception. 1984 April; 29(4): 305-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6430638

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Ovulation detection following removal of levonorgestrel subdermal contraceptive implants. Author(s): Ismail AA, Anwar MY, Youssef SM, Toppozada M. Source: Contraception. 1987 March; 35(3): 207-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3111783

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Ovulation inhibition with a combined oral contraceptive containing 20 micrograms ethinyl estradiol and 250 micrograms levonorgestrel. Serum levels of the active ingredients and FSH, LH, estradiol 17-beta and progesterone. Author(s): Lunell NO, Carlstrom K, Zador G. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1979; 88: 17-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=294110

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Ovulation inhibition with different doses of levonorgestrel and other progestogens: clinical and experimental investigations. Author(s): Spona J, Schneider WH, Bieglmayer C, Schroeder R, Pirker R. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1979; 88: 7-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=393050

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Ovulatory dysfunction during continuous administration of low-dose levonorgestrel by subdermal implants. Author(s): Faundes A, Brache V, Tejada AS, Cochon L, Alvarez-Sanchez F. Source: Fertility and Sterility. 1991 July; 56(1): 27-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1906017

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Patient satisfaction and side effects with levonorgestrel implant (Norplant) use in adolescents 18 years of age or younger. Author(s): Berenson AB, Wiemann CM. Source: Pediatrics. 1993 August; 92(2): 257-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8337026

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Patient satisfaction with a levonorgestrel-releasing contraceptive implant. Reasons for and patterns of removal. Author(s): Haugen MM, Evans CB, Kim MH. Source: J Reprod Med. 1996 November; 41(11): 849-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8951137

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Percutaneous estradiol gel with an intrauterine levonorgestrel releasing device or natural progesterone in hormone replacement therapy. Author(s): Suvanto-Luukkonen E, Sundstrom H, Penttinen J, Laara E, Pramila S, Kauppila A. Source: Maturitas. 1997 April; 26(3): 211-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9147353

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Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri and postmenopausal women. Author(s): Wildemeersch D, Schacht E, Wildemeersch P. Source: Maturitas. 2003 March 28; 44(3): 237-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648887

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Pharmacokinetic and pharmacodynamic effects of vaginal rings releasing levonorgestrel at a rate of 27 micrograms/24 hours: a pilot study. Author(s): Landgren BM, Aedo AR, Johannisson E, Cekan SZ. Source: Contraception. 1994 February; 49(2): 139-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8143453

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Pharmacokinetic study of different dosing regimens of levonorgestrel for emergency contraception in healthy women. Author(s): Johansson E, Brache V, Alvarez F, Faundes A, Cochon L, Ranta S, Lovern M, Kumar N. Source: Human Reproduction (Oxford, England). 2002 June; 17(6): 1472-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12042264

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Pharmacokinetics of ethinylestradiol and levonorgestrel after administration of two oral contraceptive preparations. Author(s): Carol W, Klinger G, Jager R, Kasch R, Brandstadt A. Source: Exp Clin Endocrinol. 1992; 99(1): 12-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1628691

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Pharmacokinetics of levonorgestrel 0.75 mg tablets. Author(s): Kook K, Gabelnick H, Duncan G. Source: Contraception. 2002 July; 66(1): 73-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12169384

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Pharmacokinetics of levonorgestrel and ethinylestradiol in 14 women during three months of treatment with a tri-step combination oral contraceptive: serum protein binding of levonorgestrel and influence of treatment on free and total testosterone levels in the serum. Author(s): Kuhnz W, Staks T, Jutting G. Source: Contraception. 1994 December; 50(6): 563-79. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7705098

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Pharmacokinetics of levonorgestrel and ethinylestradiol in 9 women who received a low-dose oral contraceptive over a treatment period of 3 months and, after a wash-out phase, a single oral administration of the same contraceptive formulation. Author(s): Kuhnz W, al-Yacoub G, Fuhrmeister A. Source: Contraception. 1992 November; 46(5): 455-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1458892

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Pharmacokinetics of levonorgestrel in 12 women who received a single oral dose of 0.15 mg levonorgestrel and, after a washout phase, the same dose during one treatment cycle. Author(s): Kuhnz W, al-Yacoub G, Fuhrmeister A. Source: Contraception. 1992 November; 46(5): 443-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1458891

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Pregnancy during the use of levonorgestrel intrauterine system. Author(s): Backman T, Rauramo I, Huhtala S, Koskenvuo M. Source: American Journal of Obstetrics and Gynecology. 2004 January; 190(1): 50-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14749634

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Prevalence of enlarged ovarian follicles among users of levonorgestrel subdermal contraceptive implants (Norplant). Author(s): Alvarez-Sanchez F, Brache V, de Oca VM, Cochon L, Faundes A. Source: American Journal of Obstetrics and Gynecology. 2000 March; 182(3): 535-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10739504

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Progestagen-only oral contraceptives: comparison of the metabolic effects of levonorgestrel and norethisterone. Author(s): Ball MJ, Ashwell E, Gillmer MD. Source: Contraception. 1991 September; 44(3): 223-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1764941

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Progestin receptor isoforms and prostaglandin dehydrogenase in the endometrium of women using a levonorgestrel-releasing intrauterine system. Author(s): Critchley HO, Wang H, Kelly RW, Gebbie AE, Glasier AF. Source: Human Reproduction (Oxford, England). 1998 May; 13(5): 1210-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647549

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Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Author(s): Sivin I, Stern J, Coutinho E, Mattos CE, el Mahgoub S, Diaz S, Pavez M, Alvarez F, Brache V, Thevenin F, et al. Source: Contraception. 1991 November; 44(5): 473-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1797462

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Prospective comparison study of levonorgestrel IUD versus Roller-Ball endometrial ablation in the management of refractory recurrent hypermenorrhea. Author(s): Romer T. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 May; 90(1): 27-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10767506

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Prospective multicentre study comparing levonorgestrel implants with a combined contraceptive pill: final results. Author(s): Kirkman RJ, Bromham DR, O'Connor TP, Sahota JE. Source: Br J Fam Plann. 1999 July; 25(2): 36-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10454652

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Protease activated receptor-1 is down regulated by levonorgestrel in endometrial stromal cells. Author(s): Hague S, Oehler MK, MacKenzie IZ, Bicknell R, Rees MC. Source: Angiogenesis. 2002; 5(1-2): 93-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12549865

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Protein S levels are lower in women receiving desogestrel-containing combined oral contraceptives (COCs) than in women receiving levonorgestrel-containing COCs at steady state and on cross-over. Author(s): Mackie IJ, Piegsa K, Furs SA, Johnson J, Bounds W, Machin SJ, Guillebaud J. Source: British Journal of Haematology. 2001 June; 113(4): 898-904. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11442481

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Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Author(s): Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivela A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J. Source: Lancet. 2001 January 27; 357(9252): 273-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11214131

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Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Author(s): Paul AC, Choy CC. Source: British Journal of Obstetrics and Gynaecology. 1999 May; 106(5): 512. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10430209

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Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Author(s): Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkila A, Walker JJ, Cameron IT. Source: British Journal of Obstetrics and Gynaecology. 1998 June; 105(6): 592-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647148

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Randomised controlled trial exists of levonorgestrel intrauterine system for menorrhagia. Author(s): Ikomi A, Gupta N. Source: Bmj (Clinical Research Ed.). 1998 October 31; 317(7167): 1250. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9794876

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Randomized clinical trial with intrauterine devices (levonorgestrel intrauterine device (LNG), CuT 380Ag, CuT 220C and CuT 200B). A 36-month study. Indian Council of Medical Research Task Force on IUD. Author(s): Baveja R, Bichille LK, Coyaji KJ, Engineer AD, Gogoi MP, Hazra MN, Kochhar M, Lahiri BC, Manuel M, Nanda UK, et al. Source: Contraception. 1989 January; 39(1): 37-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2491981

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Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up. Author(s): Pakarinen P, Toivonen J, Luukkainen T. Source: Contraception. 2003 July; 68(1): 31-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12878284

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Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. Author(s): Sivin I, Stern J, Diaz S, Pavez M, Alvarez F, Brache V, Mishell DR Jr, Lacarra M, McCarthy T, Holma P, et al. Source: American Journal of Obstetrics and Gynecology. 1992 April; 166(4): 1208-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1566771

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Recovery of fertility after use of the levonorgestrel 20 mcg/d or Copper T 380 Ag intrauterine device. Author(s): Belhadj H, Sivin I, Diaz S, Pavez M, Tejada AS, Brache V, Alvarez F, Shoupe D, Breaux H, Mishell DR Jr, et al. Source: Contraception. 1986 September; 34(3): 261-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3098498

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Reference period analysis of vaginal bleeding with triphasic oral contraceptive agents containing norethindrone or levonorgestrel: a comparison study. Author(s): Schwarz BE, Pierce C, Walden CE, Knopp RH. Source: Int J Fertil. 1992 May-June; 37(3): 176-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1355765

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Regulation of matrix metalloproteinase-9 in endometrium during the menstrual cycle and following administration of intrauterine levonorgestrel. Author(s): Skinner JL, Riley SC, Gebbie AE, Glasier AF, Critchley HO. Source: Human Reproduction (Oxford, England). 1999 March; 14(3): 793-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10221716

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Release rates of levonorgestrel from Silastic capsules, homogeneous rods and covered rods in humans. Author(s): Robertson DN, Sivin I, Nash HA, Braun J, Dinh J. Source: Contraception. 1983 May; 27(5): 483-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6411428

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Removal of deeply inserted, nonpalpable levonorgestrel (Norplant) implants. Author(s): Sarma SP, Wamsher JG, Whitlock SW. Source: Contraception. 1996 March; 53(3): 159-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8689880

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Removal of levonorgestrel capsules from the biceps muscle. Author(s): Creinin MD, Klaisle CM. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 August; 50(2): 189-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7589757

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Removal rates of subdermal levonorgestrel implants. Author(s): van Amerongen D. Source: J Reprod Med. 1994 November; 39(11): 873-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7853277

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Research on mifepristone and levonorgestrel in comparison with the Yuzpe regimen. Author(s): von Hertzen H. Source: J Am Med Womens Assoc. 1998; 53(5 Suppl 2): 222-4, 232. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9859626

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Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Author(s): Andersson K, Batar I, Rybo G. Source: Contraception. 1992 December; 46(6): 575-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1493717

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Risk of venous thromboembolism among users of third generation oral contraceptives compared with users of oral contraceptives with levonorgestrel before and after 1995: cohort and case-control analysis. Author(s): Jick H, Kaye JA, Vasilakis-Scaramozza C, Jick SS. Source: Bmj (Clinical Research Ed.). 2000 November 11; 321(7270): 1190-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11073511

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Risk of venous thromboembolism from oral contraceptives containing gestodene and desogestrel versus levonorgestrel: a meta-analysis and formal sensitivity analysis. Author(s): Hennessy S, Berlin JA, Kinman JL, Margolis DJ, Marcus SM, Strom BL. Source: Contraception. 2001 August; 64(2): 125-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11704089

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Risk of venous thromboembolism with cyproterone or levonorgestrel contraceptives. Author(s): Vasilakis-Scaramozza C, Jick H. Source: Lancet. 2001 October 27; 358(9291): 1427-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11705493

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Risks and benefits, advantages and disadvantages of levonorgestrel-releasing contraceptive implants. Author(s): Sivin I. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 2003; 26(5): 303-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12650633

52

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Safety and efficacy of a continuous once-a-week 17beta-estradiol/levonorgestrel transdermal system and its effects on vasomotor symptoms and endometrial safety in postmenopausal women: the results of two multicenter, double-blind, randomized, controlled trials. Author(s): Shulman LP, Yankov V, Uhl K. Source: Menopause (New York, N.Y.). 2002 May-June; 9(3): 195-207. Erratum In: Menopause. 2002 September-October; 9(5): 385. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11973443

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Safety and efficacy of levonorgestrel implant, intrauterine device, and sterilization. Author(s): Meirik O, Farley TM, Sivin I. Source: Obstetrics and Gynecology. 2001 April; 97(4): 539-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11275025

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Salivary and plasma free testosterone and androstenedione levels in women using oral contraceptives containing desogestrel or levonorgestrel. Author(s): Swinkels LM, Meulenberg PM, Ross HA, Benraad TJ. Source: Annals of Clinical Biochemistry. 1988 July; 25 ( Pt 4): 354-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2975155

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Scanning electron microscopic (SEM) changes of the endometrium in women taking high doses of levonorgestrel as emergency postcoital contraception. Author(s): Ugocsai G, Rozsa M, Ugocsai P. Source: Contraception. 2002 December; 66(6): 433-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499036

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Selection and performance of the levonorgestrel-releasing intrauterine system. Author(s): Lahteenmaki P, Bardin CW, Elomaa K, Haukkamaa M, Kivijarvi A, Kuukankorpi A, Venhola M, Tuominen J. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1997; 164: 69-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9225643

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Serum concentrations of estradiol, progesterone, and levonorgestrel are not determinants of endometrial histology or abnormal bleeding in long-term Norplant implant users. Author(s): Darney PD, Taylor RN, Klaisle C, Bottles K, Zaloudek C. Source: Contraception. 1996 February; 53(2): 97-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8838486

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Serum lipids and lipoproteins in postmenopausal women receiving transdermal oestrogen in combination with a levonorgestrel-releasing intrauterine device. Author(s): Raudaskoski TH, Tomas EI, Paakkari IA, Kauppila AJ, Laatikainen TJ. Source: Maturitas. 1995 June; 22(1): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7666816

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Serum lipids in postmenopausal or perimenopausal women using estrogen alone, estrogen with levonorgestrel, or estrogen with norethisterone, compared with nonusers: results from a cross-sectional study in two Norwegian counties 1985-1988. Author(s): Graff-Iversen S, Stensvold I, Lund-Larsen PG, Nodarse LO, Tverdal A, Urdal P. Source: Journal of Clinical Epidemiology. 1998 December; 51(12): 1311-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10086825

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Serum protein binding characteristics of cyproterone acetate, gestodene, levonorgestrel and norethisterone in rat, rabbit, dog, monkey and man. Author(s): Li QG, Humpel M. Source: J Steroid Biochem. 1990 February; 35(2): 319-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2137890

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Serum SHBG levels during normal menstrual cycle and after insertion of levonorgestrel-releasing IUD. Author(s): Jia MC, Zhou LY, Ren S, Dong L, Xiao B. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1992 March; 8(1): 33-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1590100

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Sex hormone binding globulin and free levonorgestrel index in the first week after insertion of Norplant implants. Author(s): Alvarez F, Brache V, Tejada AS, Cochon L, Faundes A. Source: Contraception. 1998 October; 58(4): 211-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9866001

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Short term effects of SHD 386L and levonorgestrel on bone and mineral metabolism in the postmenopause: a double-blind randomised placebo-controlled trial. Author(s): Purdie DW, Hay AW, Everett M. Source: Maturitas. 1992 March; 14(3): 189-99. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1508060

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Short-term treatment with levonorgestrel does not antagonize the ethinyl estradiolinduced increase of uterine blood flow in postmenopausal women. Author(s): Entezami M, Heger-Mahn D, Ebert A, Halis G, Lubbert H. Source: Contraception. 1997 September; 56(3): 181-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9347210

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Sixty thousand woman-years of experience on the levonorgestrel intrauterine system: an epidemiological survey in Finland. Author(s): Backman T, Huhtala S, Tuominen J, Luoto R, Erkkola R, Blom T, Rauramo I, Koskenvuo M. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2001 January; 6 Suppl 1: 23-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11336430

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Studies on a vaginal ring releasing levonorgestrel at an initial rate of 27 micrograms/24 h when used alone or in combination with transdermal systems releasing estradiol. Author(s): Landgren BM, Aedo AR, Johannisson E, Cekan SZ. Source: Contraception. 1994 July; 50(1): 87-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7924325

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Subdermal levonorgestrel implants. Three years' experience in Cairo, Egypt. Author(s): Rizk DE. Source: J Reprod Med. 1995 September; 40(9): 638-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8576880

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Successful use of levonorgestrel intrauterine system in a HIV positive woman. Author(s): Cooling H. Source: Br J Fam Plann. 1999 April; 25(1): 25-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10228247

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Surface vascularization and endometrial appearance in women with menorrhagia or using levonorgestrel contraceptive implants. Implications for the mechanisms of breakthrough bleeding. Author(s): Hickey M, Fraser IS. Source: Human Reproduction (Oxford, England). 2002 September; 17(9): 2428-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12202436

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Sustained-release estradiol implants and a levonorgestrel-releasing intrauterine device in hormone replacement therapy. Author(s): Suhonen SP, Allonen HO, Lahteenmaki P. Source: American Journal of Obstetrics and Gynecology. 1995 February; 172(2 Pt 1): 5627. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7856686

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Systemic availability of levonorgestrel after single oral administration of a norgestimate-containing combination oral contraceptive to 12 young women. Author(s): Kuhnz W, Blode H, Mahler M. Source: Contraception. 1994 March; 49(3): 255-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8200219

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The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia. Author(s): Mercorio F, De Simone R, Di Spiezio Sardo A, Cerrota G, Bifulco G, Vanacore F, Nappi C. Source: Contraception. 2003 April; 67(4): 277-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684148

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The effect of a levonorgestrel-releasing intrauterine system on angiogenic growth factors in the endometrium. Author(s): Roopa BA, Loganath A, Singh K. Source: Human Reproduction (Oxford, England). 2003 September; 18(9): 1809-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12923132

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The effect of ethinyloestradiol and levonorgestrel on the CYP2C19-mediated metabolism of omeprazole in healthy female subjects. Author(s): Palovaara S, Tybring G, Laine K. Source: British Journal of Clinical Pharmacology. 2003 August; 56(2): 232-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12895199

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The effect of extending the pill-free interval on follicular activity: triphasic norgestimate/35 micro g ethinyl estradiol versus monophasic levonorgestrel/20 micro g ethinyl estradiol. Author(s): Creinin MD, Lippman JS, Eder SE, Godwin AJ, Olson W. Source: Contraception. 2002 September; 66(3): 147-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12384201

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The effect of low dose nylestriol-levonorgestrel replacement therapy on bone mineral density in women with postmenopausal osteoporosis. Author(s): Liao EY, Luo XH, Deng XG, Wu XP, Liao HJ, Wang PF, Mao JP, Zhu XP, Huang G, Wei QY. Source: Endocrine Research. 2003 May; 29(2): 217-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856809

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The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. Author(s): Hurskainen R, Paavonen J, Teperi J. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 January; 110(1): 87-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12504952

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The effects of levonorgestrel on various sperm functions. Author(s): Yeung WS, Chiu PC, Wang CH, Yao YQ, Ho PC. Source: Contraception. 2002 December; 66(6): 453-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499039

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The effects of the levonorgestrel intrauterine system (Mirena coil) on endometrial morphology. Author(s): Phillips V, Graham CT, Manek S, McCluggage WG. Source: Journal of Clinical Pathology. 2003 April; 56(4): 305-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663645

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The in vitro effect of levonorgestrel on the acrosome reaction of human spermatozoa from fertile men. Author(s): Bahamondes L, Nascimento JA, Munuce MJ, Fazano F, Faundes A. Source: Contraception. 2003 July; 68(1): 55-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12878288

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The intrinsic transcriptional estrogenic activity of a non-phenolic derivative of levonorgestrel is mediated via the estrogen receptor-alpha. Author(s): Garcia-Becerra R, Borja-Cacho E, Cooney AJ, Jackson KJ, Lemus AE, PerezPalacios G, Larrea F. Source: The Journal of Steroid Biochemistry and Molecular Biology. 2002 November; 82(4-5): 333-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12589940

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The levonorgestrel intrauterine system: a simple and effective alternative for the management of menorrhagia? Author(s): Farquhar CM. Source: The Medical Journal of Australia. 2002 October 21; 177(8): 444-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12381255

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The levonorgestrel intra-uterine system: therapeutic application in family planning. Author(s): Dolan LM, Mulholland M, Price J. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2001 January; 27(1): 19-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12457542

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The levonorgestrel two-rod implant for long-acting contraception: 10 years of clinical experience. Author(s): Wan LS, Stiber A, Lam LY. Source: Obstetrics and Gynecology. 2003 July; 102(1): 24-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12850601

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The local progestational effect of the levonorgestrel-releasing intrauterine system: a sonographic and Doppler flow study. Author(s): Zalel Y, Shulman A, Lidor A, Achiron R, Mashiach S, Gamzu R. Source: Human Reproduction (Oxford, England). 2002 November; 17(11): 2878-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407042

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The male contraceptive regimen of testosterone and levonorgestrel significantly increases lean mass in healthy young men in 4 weeks, but attenuates a decrease in fat mass induced by testosterone alone. Author(s): Herbst KL, Anawalt BD, Amory JK, Matsumoto AM, Bremner WJ. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 March; 88(3): 116773. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629101

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The progestative effect of the levonorgestrel-releasing intrauterine system--when does it manifest? Author(s): Zalel Y, Gamzu R, Shulman A, Achiron R, Schiff G, Lidor A. Source: Contraception. 2003 June; 67(6): 473-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814817

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Therapeutic effects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia. Author(s): Xiao B, Wu SC, Chong J, Zeng T, Han LH, Luukkainen T. Source: Fertility and Sterility. 2003 April; 79(4): 963-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12749438

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Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy. Author(s): Bourdrez P, Bongers MY, Mol BW. Source: Fertility and Sterility. 2004 July; 82(1): 160-6, Quiz 265. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15237006

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Treatment of nonatypical and atypical endometrial hyperplasia with a levonorgestrelreleasing intrauterine system. Author(s): Wildemeersch D, Dhont M. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1297-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748501

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Two cases of abortion and premature birth after removal of a levonorgestrel-releasing intrauterine system. Author(s): Rollnik JD, Luck HJ, Giersig C. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2002 December; 7(4): 244-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648298

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Ultrastructural comparative study on endometrium of Chinese women using intrauterine devices of stainless steel ring, copper T220, and releasing levonorgestrel: morphometry of microvessels. Author(s): Wang JD, Zhu PD, Cheng J, Luo HZ, Xu RH, Hu WW. Source: Contraception. 1990 April; 41(4): 389-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2335103

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Update on levonorgestrel for emergency contraception. Author(s): Strayer SM, Couchenour RL. Source: The Journal of Family Practice. 1999 December; 48(12): 1002. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10628586

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Use of 0.75 mg Levonorgestrel for postcoital contraception in Thailand. Author(s): Lerkiatbundit S, Reanmongkol W. Source: Journal of Clinical Pharmacy and Therapeutics. 2000 June; 25(3): 185-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10886463

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Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Author(s): Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Source: Fertility and Sterility. 2001 March; 75(3): 485-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11239528

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Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Author(s): Grigorieva V, Chen-Mok M, Tarasova M, Mikhailov A. Source: Fertility and Sterility. 2003 May; 79(5): 1194-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738516

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Use of levonorgestrel implants versus oral contraceptives in adolescence: a casecontrol study. Author(s): Berenson AB, Wiemann CM. Source: American Journal of Obstetrics and Gynecology. 1995 April; 172(4 Pt 1): 1128-35; Discussion 1135-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7726249

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Use of the New Zealand Intensive Medicines Monitoring Programme to study the levonorgestrel-releasing intrauterine device (Mirena). Author(s): Zhou L, Harrison-Woolrych M, Coulter DM. Source: Pharmacoepidemiology and Drug Safety. 2003 July-August; 12(5): 371-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12899110

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Users' perspectives on bleeding patterns after two years of levonorgestrel-releasing intrauterine system use. Author(s): Nascimento R, Bahamondes L, Hidalgo M, Perrotti M, Espejo-Arce X, Petta CA. Source: Drugs in R&D. 2002; 3(6): 387-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12516941

•

Using a low-dose contraceptive in women 35 years of age and over: 20 microg estradiol/100 microg levonorgestrel. Author(s): Carr BR, DelConte A. Source: Contraception. 2002 June; 65(6): 397-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12127636

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Uterine perforation and laparoscopic retrieval of a levonorgestrel intrauterine system (Mirena). Author(s): Selo-Ojeme DO, Ekong ME, Welch CC. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 445-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12881099

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CHAPTER 2. NUTRITION AND LEVONORGESTREL Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and levonorgestrel.

Finding Nutrition Studies on Levonorgestrel The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “levonorgestrel” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “levonorgestrel” (or a synonym): •

Dual-controlled drug delivery across biodegradable copolymer. I. Delivery kinetics of levonorgestrel and estradiol through (caprolactone/lactide) block copolymer. Author(s): Controlled Drug-Delivery Research Center, College of Pharmacy, Rutgers University, Piscataway, New Jersey 08854, USA. Source: Ye, W P Chien, Y W Pharm-Dev-Technol. 1996 April; 1(1): 1-9 1083-7450

•

Influence of ethinylestradiol-containing combination oral contraceptives with gestodene or levonorgestrel on caffeine elimination. Author(s): Department of Clinical Pharmacology, Friedrich Schiller University, Jena, Germany. Source: Balogh, A Klinger, G Henschel, L Borner, A Vollanth, R Kuhnz, W Eur-J-ClinPharmacol. 1995; 48(2): 161-6 0031-6970

•

The levonorgestrel intrauterine system in menopausal hormone replacement therapy: five-year experience. Author(s): Department of Obstetrics and Gynaecology, Oulu University Hospital, Finland. [email protected] Source: Suvanto Luukkonen, E Kauppila, A Fertil-Steril. 1999 July; 72(1): 161-3 0015-0282

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to levonorgestrel; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Ascorbic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin C (Ascorbic Acid) Source: Integrative Medicine Communications; www.drkoop.com

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CHAPTER 3. PATENTS ON LEVONORGESTREL Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “levonorgestrel” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on levonorgestrel, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Levonorgestrel By performing a patent search focusing on levonorgestrel, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on levonorgestrel: •

L-.alpha.-amino acids as transdermal penetration enhancers Inventor(s): Daniels; Charles R. (Erdenheim, PA), Gaskill; James L. (Devon, PA), Giannini; Robert P. (East Norriton, PA), Sarpotdar; Pramod P. (Audubon, PA) Assignee(s): American Home Products Corporation (New York, NY) Patent Number: 4,732,892 Date filed: July 12, 1985 Abstract: The disclosed invention provides methods and compositions ulilizing L.alpha.-amino acids for enhancing the rate of penetration through the skin of both topical medicaments and of drugs employed for systemic administration. Fifteen L.alpha.-amino acids were tested and found to enhance the rate of penetration of levonorgestrel through hairless mouse skin. These were Tryptophan, Glutamic Acid, Glycine, Proline, Alanine, Serine, Arginine, Aspartic Acid, Leucine, Isoleucine, Cysteine, Valine,.alpha.-Aminobutyric Acid, Norvaline and Norleucine. The effect of pH on the rate of penetration of the various amino acids was also examined and found to be unpredictable overall. Excerpt(s): This invention provides a method and pharmaceutical compositions for enhancing the rate of penetration of drugs or medications through the skin. The enhanced rate of transdermal penetration provided by the invention is attained by including in the transdermal drug delivery system an amount of an L-.alpha.-amino acid. The invention also comprises transdermal drug delivery systems containing an L.alpha.-amino acid as a penetration enhancer. Preferred L-.alpha.-amino acids useful for enhancing the rate of penetration in transdermal drug delivery systems are Tryptophan, Alanine, Arginine, Proline, Serine, Aspartic Acid, Cysteine, Glutamic Acid, Glycine, Isoleucine, Leucine, Valine,.alpha.-Aminobutyric Acid, Norvaline and Norleucine. Particularly preferred L-.alpha.-amino acids are Valine, Cysteine, Leucine, Isoleucine,.alpha.-Aminobutyric Acid, Norvaline and Norleucine. A low rate of penetration of drug through the skin is one of the major obstacles to the development of transdermal delivery systems. In many cases, the area of the skin which must be in contact with drug is prohibitively large unless the rate of penetration is increased. Various compounds or compositions have been found to increase the rate of penetration of particular drugs. For example, U.S. Pat. No. 3,527,864 discloses that dimethylsulfoxide and homologous low molecular weight sulfoxides, when used in solvent concentrations, e.g. 50 percent or more, enhance the rate of penetration of various substances. However, these low molecular weight sulfoxides are absorbed systemically where they cause undesireable side effects. Said U.S. Pat. No. 3,527,864 claims the use of higher molecular weight (C.sub.8 -C.sub.13) sulfoxides in amounts of 0.1 to 10.0 percent by weight to enhance the penetration of various antimicrobial agents used for topical treatment. Web site: http://www.delphion.com/details?pn=US04732892__

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•

Non-contaminating direct serum assay of steroid hormones Inventor(s): Mishell; Daniel R. (Palos Verdes Estates, CA), Nakamura; Robert M. (Rolling Hills Estates, CA), Stumpf; Paul G. (Palmyra, PA) Assignee(s): University of Southern California (Los Angeles, CA) Patent Number: 4,477,577 Date filed: September 18, 1981 Abstract: A method for direct serum assay of steroid hormones wherein the competition from binding protein, having an affinity for complexing with the steroid hormones, is significantly eliminated by adding to the serum an artificial compound which has a greater or equal affinity for the binding protein than do the steroid hormones, and which is not immuno-reactive with the steroid hormones. Because the compound is artificial, it is non-contaminating. Levonorgestrel and norethindrone as such compounds are disclosed. Excerpt(s): This invention relates generally to a novel method of direct serum assay of steroid hormones of the type conducted without the need to extract the hormones from the serum prior to assay. More particularly, this invention concerns reducing or eliminating the binding protein competition from interacting with steroid hormones prior to the stage in the assay when the bound or unbound antigen (tagged and untagged) is separated for counting, by adding an artificial compound having a greater or equal affinity for the binding protein than do the steroid hormones, and which is nonimmuno-reactive with the steroid hormones. Because the compound is artificial, it is non-contaminating. where the * indicates the model or tagged antigen is modified in some way, as by tagging with a radionuclide or an enzyme, which will enable quantitation in the assay. Correspondingly, the percentage of the tagged antigen remaining in the separated unbound portion of the serum increases as the amount of available untagged antigen, for which the assay is being conducted, increases in the serum sample. Web site: http://www.delphion.com/details?pn=US04477577__

•

Oral contraceptive Inventor(s): Gast; Michael J. (Phoenixville, PA) Assignee(s): American Home Products Corporation (Madison, NJ) Patent Number: 5,747,480 Date filed: April 17, 1997 Abstract: This invention provides a method of contraception which comprises administering to a female of child bearing age for 28 consecutive days,a first phase combination of a progestin at a daily dosage equivalent in progestational activity to 40125.mu.g levonorgestrel and an estrogen at a daily dosage equivalent in estrogenic activity to 10-20.mu.g ethinyl estradiol for 3-8 days beginning on day 1 of the menstrual cycle, wherein the same dosage of the progestin and estrogen combination is administered in each of the 3-8 days,a second phase combination of a progestin at a daily dosage equivalent in progestational activity to 40-125.mu.g levonorgestrel and an estrogen at a daily dosage equivalent in estrogenic activity to 10-20.mu.g ethinyl estradiol, for 4-15 days beginning on the day immediately following the last day of administration of the first phase combination, wherein the same dosage of the progestin

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and estrogen combination is administered in each of the 4-15 days,a third phase combination of a progestin at a daily dosage equivalent in progestational activity to 40125.mu.g levonorgestrel and an estrogen at a daily dosage equivalent in estrogenic activity to 10-20.mu.g ethinyl estradiol, for 4-15 days beginning on the day immediately following the last day of administration of the second phase combination, wherein the same dosage of the progestin and estrogen combination is administered in each of the 415 days, andan estrogen phase estrogen at a daily dosage equivalent in estrogenic activity to 10-20.mu.g ethinyl estradiol, for 3-5 days beginning on the day immediately following the last day of administration of the third phase combination, wherein the same dosage of the estrogen is administered in each of the 3-5 days,provided that the daily dosage of the combination administered in the first phase is not the same as the daily dosage of the combination administered in the second phase and that the daily dosage of the combination administered in the second phase is not the same as the daily dosage of the combination administered in the third phase. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/017,092, filed May 8, 1996. The vast majority of oral contraceptives consist of a combination of a progestin and estrogen that are administered concurrently for 21 days followed either by a 7 day pill free interval or by the administration of a placebo for 7 days in each 28 day cycle. The most important aspects of a successful oral contraceptive product are effective contraception, good cycle control (absence of spotting and breakthrough bleeding and occurrence of withdrawal bleeding), and minimal side effects. Combination oral contraceptives have traditionally acted by suppression of gonadotropins. In addition, it appears that the progestin component is primarily responsible for contraceptive efficacy through inhibition of ovulation, and other peripheral effects which include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation). The estrogenic component intensifies the anovulatory effect of the progestin, and is also important for maintaining cycle control. Since the introduction of oral contraceptives (OCs) over a quarter-century ago, research has been directed toward developing preparations that minimize the potential for side effects while maintaining efficacy and normal menstrual patterns. The first- generation OCs contained more progestin and estrogen than was necessary to prevent conception. Adverse hemostatic and metabolic changes, clinical problems, and side effects were associated with these high-dose preparations. In 1978, the World Health Organization (WHO) recommended that the focus of OC research should be the development of products containing the lowest possible dose levels of estrogen and progestin. Web site: http://www.delphion.com/details?pn=US05747480__ •

Therapeutical system for transdermal delivery of levonorgestrel Inventor(s): Arth; Christoph (Dusseldorf, DE), Wolff; Hans-Michael (Monheim, DE) Assignee(s): Schwarz Pharma AG (Monheim, DE) Patent Number: 6,555,131 Date filed: March 9, 2000 Abstract: A stable therapeutical transdermal system for the transcutaneous delivery of levonorgestrel, alone or together with other sex steroid hormones, over a long time period is disclosed. A method of producing the transdermal system that avoids the use of solvents and avoids degradation of the steroid hormones also is disclosed.

Patents 69

Excerpt(s): The present invention concerns a Transdermal Therapeutic System (TTS) for the administration of levonorgestrel alone or with other steroid sex hormones through the skin over a longer period of time, as well as a method for its production without the use of solvents, the method being especially protective for the active ingredient. The bioavailability of orally administered active ingredients is frequently unsatisfactory. Metabolization of many active ingredients in the liver can lead during the first passage through the liver to undesirable concentration relationships, toxic by-products and to the reduction of the activity and even to loss of activity. In comparison to oral administration, transdermal administration of active ingredients has various advantages. The introduction of the active ingredient can be controlled better over a longer period of time as a result of which high fluctuations in blood level are avoided. In addition, the required therapeutic effective dose can mostly be reduced significantly. In addition, patients frequently prefer a plaster to tablets, which must be taken once or several times daily. In the past, in order to overcome the disadvantages of nontransdermal administration of active ingredients mentioned above, a number of transdermal therapeutic systems (TTS) with different structure were proposed for various active ingredients for the therapy of different diseases. Web site: http://www.delphion.com/details?pn=US06555131__ •

Transdermal fertility control system and process Inventor(s): Chien; Te-Yen (Piscataway, NJ), Chien; Yie W. (North Brunswick, NJ), Huang; Yih-Chain (Piscataway, NJ) Assignee(s): Rutgers, The State University of New Jersey (New Brunswick, NJ) Patent Number: 4,818,540 Date filed: August 29, 1986 Abstract: Transdermal fertility-controlling absorption polymer matrix dosage units have been developed which comprise a backing layer, an adjoining layer of a solid polymer matrix in which minimum effective daily doses of an estrogen and a progestin are microdispersed and released for transdermal absorption. Presently preferred is use of the natural estrogen, 17-beta-estradiol, and of the progestin, levonorgestrel. The units have a biologically acceptable adhesive polymer layer. The polymer matrix as well as the adhesive layer can have dispersed one or more skin permeation enhancers. Dosage units are provided which transdermally deliver at least minimum daily doses of the estrogen and progestin for multiple days, such as for one week. The invention also provides a process of fertility control using the novel polymer matrix dosage units for the first three weeks of consecutive menstrual cycles of the subject desiring fertility control. Excerpt(s): The following examples are in illustration of the invention and are not intended to be limiting. The following ingredients are used in making the hormonecontaining polymer matrix discs: 17-beta-estradiol, 1 part; levonorgestrel, 2.5 parts; DC360 polysiloxane medical fluid (20 cps), 12.4 parts; silicone (medical-grade) 382 elastomer (Silasti.RTM. 382 elastomer, Dow Corning Corporation), 74.1 parts; 10 parts of 40 percent (V/V) PEG 400/water (W/W); catalyst M, 20 drops per 100 g. of the mixture. The 17-beta-estradiol and levonorgestrel are thoroughly mixed in the PEG 400/water solution by using a high torque mixer (sold by Cole-Parmer Company) at about 1000 RPM, to form a mixture of paste-like consistency. Web site: http://www.delphion.com/details?pn=US04818540__

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Patent Applications on Levonorgestrel As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to levonorgestrel: •

17Beta- estradiol/levonorgestrel transdermal patch for hormone replacement therapy Inventor(s): Shulman, Lee; (Chicago, IL), Uhl, Kerstin; (Berlin, DE), Yankov, Vladimir; (Montville, NJ) Correspondence: Millen, White, Zelano & Branigan, P.C.; 2200 Clarendon BLVD.; Suite 1400; Arlington; VA; 22201; US Patent Application Number: 20040062794 Date filed: September 30, 2002 Abstract: The present invention relates to a method for reducing triglyceride levels in a patient and effecting hormone replacement therapy comprising continuously and transdermally administering an essentially constant therapeutically effective amount of a composition comprising an estradiol (17.beta.-estradiol) and a progestin (levonorgestrel (LNG)) in a pharmaceutically acceptable carrier. Excerpt(s): The present invention relates to a composition for hormone replacement therapy comprising an estrogen and a progestin in a pharmaceutically acceptable transdermal carrier. Further, the present invention relates to a method for reducing triglyceride levels in a patient undergoing hormone replacement therapy comprising administering to a patient, in need thereof, a therapeutically effective amount of said composition. It has been discovered that the continuous transdermal administration of a composition comprising 17.beta.-estradiol and levonorgestrel (LNG) in therapeutically effective concentrations of both hormones to relieve the symptoms of menopause in women, significantly reduces the level of triglycerides, which are a major risk factor for cardiovascular disease in women, and some lipoproteins. Hormone replacement therapy (HRT) has long been provided to menopausal and post-menopausal women to relieve menopausal symptoms such as hot flashes, night sweats, calcium loss from bone, and for the prevention of heart disease. These therapies usually involve administering over a time period varying amounts of hormone preparations (estrogens with or without progestins) cyclically, continuously or sequentially to a woman in need of such treatment. Menopause has also been associated with adverse changes to lipid and lipoprotein levels, some of which are important risk factors for coronary heart disease (CHD). These adverse changes include increases in total cholesterol (TC), low-density lipoproteins (LDL), and triglycerides, coupled with slight decreases in high-density lipoproteins (HDL). Many currently available combination HRT therapies have been associated with significant increases in triglyceride levels. Elevated triglycerides, in addition to being a risk factor for CHD in women, has also been associated with insulin resistance and polycystic ovarian disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

9

This has been a common practice outside the United States prior to December 2000.

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Keeping Current In order to stay informed about patents and patent applications dealing with levonorgestrel, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “levonorgestrel” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on levonorgestrel. You can also use this procedure to view pending patent applications concerning levonorgestrel. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 4. BOOKS ON LEVONORGESTREL Overview This chapter provides bibliographic book references relating to levonorgestrel. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on levonorgestrel include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “levonorgestrel” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “levonorgestrel” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “levonorgestrel” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Jadelle Levonorgestrel Rod Implants: A Summary of Scientific Data and Lessons Learned from Programmatic Experience by Irving Sivin, et al; ISBN: 0878341056; http://www.amazon.com/exec/obidos/ASIN/0878341056/icongroupinterna

•

Mirena: The Levonorgestrel Intrauterine System: The New Contraceptive Option for Parous Women by E. D. B. Johansson, Copenhagen) World Congress of Gynecology and Obstetrics 1997 Denmark; ISBN: 1850700370; http://www.amazon.com/exec/obidos/ASIN/1850700370/icongroupinterna

•

NORPLANT, levonorgestrel implants: A summary of scientific data; ISBN: 0878340580; http://www.amazon.com/exec/obidos/ASIN/0878340580/icongroupinterna

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CHAPTER 5. PERIODICALS AND NEWS ON LEVONORGESTREL Overview In this chapter, we suggest a number of news sources and present various periodicals that cover levonorgestrel.

News Services and Press Releases One of the simplest ways of tracking press releases on levonorgestrel is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “levonorgestrel” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to levonorgestrel. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “levonorgestrel” (or synonyms). The following was recently listed in this archive for levonorgestrel: •

Mifepristone, levonorgestrel regimens comparable for emergency contraception Source: Reuters Industry Breifing Date: December 05, 2002

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•

Intrauterine levonorgestrel can replace surgery for menorrhagia Source: Reuters Industry Breifing Date: March 20, 2002

•

Intrauterine levonorgestrel protects against uterine effects of tamoxifen Source: Reuters Industry Breifing Date: November 16, 2000

•

Two-rod levonorgestrel implant highly effective, easier to remove than Norplant Source: Reuters Medical News Date: January 06, 1999

•

Repeat pregnancy likely after early levonorgestrel removal Source: Reuters Medical News Date: October 26, 1998

•

Emergency contraception with levonorgestrel alone more effective than Yuzpe regimen Source: Reuters Medical News Date: August 07, 1998

•

Effects Of Intracervical, Fundal Administration Of Levonorgestrel For Contraception Elucidated Source: Reuters Medical News Date: July 01, 1997 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “levonorgestrel” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “levonorgestrel” (or synonyms). If you know the name of a company that is relevant to levonorgestrel, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “levonorgestrel” (or synonyms).

Academic Periodicals covering Levonorgestrel Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to levonorgestrel. In addition to these sources, you can search for articles covering levonorgestrel that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 6. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for levonorgestrel. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with levonorgestrel. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to levonorgestrel: Estrogens and Progestins Oral Contraceptives •

Systemic - U.S. Brands: Alesse; Brevicon; Demulen 1/35; Demulen 1/50; Desogen; Estrostep; Estrostep Fe; Genora 0.5/35; Genora 1/35; Genora 1/50; Intercon 0.5/35; Intercon 1/35; Intercon 1/50; Jenest; Levlen; Levlite; Levora 0.15/30; Lo/Ovral; Loestrin 1.5/30; Loestrin 1/20; Loestrin Fe 1.5/30; Loestrin Fe 1/20; Mircette; ModiCon; N.E.E. 1/35; N.E.E. 1/50; Necon 0.5/35; Necon 1/35; Necon 1/50; Necon 10/11; Nelova 0.5/35E; Nelova 1/35E; Nelova 1/50M; Nelova 10/11; Nordette; Norethin 1/35E; Norethin 1/50M; Norinyl 1+35; Norinyl 1+50; Ortho Tri-Cyclen; Ortho-Cept; Ortho-Cyclen; Ortho-Novum 1/35; Ortho-Novum 1/50; Ortho-Novum 10/11; Ortho-Novum 7/7/7; Ovcon-35; Ovcon-50; Ovral; Tri-Levlen; Tri-Norinyl; Triphasil; Trivora; Zovia 1/35E; Zovia 1/50E http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202228.html

Progestins For Contraceptive Use •

Systemic - U.S. Brands: Depo-Provera Contraceptive Injection; Micronor; NORPLANT System; Nor-QD; Ovrette; Plan B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202757.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter,

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Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

85

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “levonorgestrel” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3472 408 9 3 6 3898

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “levonorgestrel” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on levonorgestrel can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to levonorgestrel. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to levonorgestrel. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “levonorgestrel”:

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Epilepsy http://www.nlm.nih.gov/medlineplus/epilepsy.html Hormone Replacement Therapy http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to levonorgestrel. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to levonorgestrel. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with levonorgestrel.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about levonorgestrel. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “levonorgestrel” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “levonorgestrel”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “levonorgestrel” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “levonorgestrel” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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LEVONORGESTREL DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Ablation: The removal of an organ by surgery. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acrosome: Cap-like structure covering the nucleus and anterior part of the sperm head. [NIH]

Acrosome Reaction: Changes that occur to liberate the enzymes of the acrosome of spermatozoa that allow the entry of a spermatozoon into the ovum. [NIH] Acrylamide: A colorless, odorless, highly water soluble vinyl monomer formed from the hydration of acrylonitrile. It is primarily used in research laboratories for electrophoresis, chromatography, and electron microscopy and in the sewage and wastewater treatment industries. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and

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stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Androgenic: Producing masculine characteristics. [EU] Androstenedione: A steroid with androgenic properties that is produced in the testis, ovary, and adrenal cortex. It is a precursor to testosterone and other androgenic hormones. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign

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substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some

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cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Breast Feeding: The nursing of an infant at the mother's breast. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with

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phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH]

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Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH]

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Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraceptive Agents: Chemical substances that prevent or reduce the probability of conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyproterone: An anti-androgen that, in the form of its acetate, also has progestational properties. It is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females. [NIH] Cyproterone Acetate: An agent with anti-androgen and progestational properties. It shows competitive binding with dihydrotestosterone at androgen receptor sites. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum

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reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Desogestrel: A synthetic progestational hormone used often as the progestogenic component of combined oral contraceptive agents. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Diuresis: Increased excretion of urine. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles

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with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethinyl Estradiol: A semisynthetic estrogen with high oral estrogenic potency. It is often used as the estrogenic component in oral contraceptives. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the

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relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Follicular Phase: The period of the menstrual cycle that begins with menstruation and ends with ovulation. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to

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originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

High-density lipoproteins: Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels

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are inversely correlated with coronary heart disease risk. [NIH] Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Histology: The study of tissues and cells under a microscope. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hydration: Combining with water. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hysterectomy: Excision of the uterus. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

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Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH]

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Insulin-like: Muscular growth factor. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Lactation: The period of the secretion of milk. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or

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site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medroxyprogesterone Acetate: An injectable contraceptive, generally marketed under the name Depo-Provera. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menorrhagia: Excessive menstrual flow. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU]

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Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbicide: Any substance (gels, creams, suppositories, etc.) that can reduce transmission of sexually transmitted infections. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microgram: A unit of mass (weight) of the metric system, being one-millionth of a gram (106 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Mifepristone: A progestational and glucocorticoid hormone antagonist. Its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. As a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary Cushing syndrome. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000-times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological

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Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: A type of white blood cell. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent,

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albuminous fluid in which the ovum is suspended. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovulation Induction: Techniques for the artifical induction of ovulation. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative

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logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH]

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Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postmenopause: The physiological period following the menopause, the permanent cessation of the menstrual life. Since in the United States the age of the menopause ranges between 48 and 55 years, generally conceived as middle age, the postmenopause often refers to women considerably older. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15-

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hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostaglandins F: (9 alpha,11 alpha,13E,15S)-9,11,15-Trihydroxyprost-13-en-1-oic acid (PGF(1 alpha)); (5Z,9 alpha,11,alpha,13E,15S)-9,11,15-trihydroxyprosta-5,13-dien-1-oic acid (PGF(2 alpha)); (5Z,9 alpha,11 alpha,13E,15S,17Z)-9,11,15-trihydroxyprosta-5,13,17-trien-1oic acid (PGF(3 alpha)). A family of prostaglandins that includes three of the six naturally occurring prostaglandins. All naturally occurring PGF have an alpha configuration at the 9carbon position. They stimulate uterine and bronchial smooth muscle and are often used as oxytocics. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radioactive: Giving off radiation. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g.,

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for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Reverse Transcriptase Polymerase Chain Reaction: A variation of the PCR technique in which cDNA is made from RNA via reverse transcription. The resultant cDNA is then amplified using standard PCR protocols. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of

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thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Selegiline: A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl. [NIH] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU]

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Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Sperm: The fecundating fluid of the male. [NIH] Sperm Head: The anterior, usually ovoid, nucleus-containing part of spermatozoa. [NIH] Spermatogenesis: Process of formation and development of spermatozoa, including spermatocytogenesis and spermiogenesis. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spermatozoon: The mature male germ cell. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spotting: A slight discharge of blood via the vagina, especially as a side-effect of oral contraceptives. [EU] Steady state: Dynamic equilibrium. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH]

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Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen

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plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterine Perforation: Penetration through the uterine wall. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]

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Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX A Ablation, 15, 16, 22, 48, 58, 103 Abortion, 15, 49, 58, 103, 119 Acne, 16, 28, 103, 109 Acrosome, 56, 103 Acrosome Reaction, 56, 103 Acrylamide, 9, 103 Acrylonitrile, 103 Adenosine, 103, 106, 121 Adjuvant, 5, 103 Adolescence, 59, 103 Adrenal Cortex, 103, 104, 111, 119, 122 Adverse Effect, 103, 125 Affinity, 67, 103 Agonist, 11, 103, 127 Alertness, 104, 106 Algorithms, 104, 106 Alimentary, 104, 120 Alkaline, 104, 106 Alternative medicine, 76, 104 Amenorrhea, 6, 104 Amino acid, 66, 104, 109, 112, 120, 122, 123, 124, 127, 128 Anaesthesia, 104, 115 Anal, 34, 104, 117 Analog, 104, 116 Androgenic, 104 Androstenedione, 52, 104 Angiogenesis, 33, 48, 104, 117 Animal model, 5, 104 Antagonism, 104, 106 Antibiotic, 5, 104 Antibodies, 104, 105, 113, 115, 117 Antibody, 103, 104, 105, 109, 113, 114, 115, 126 Anticoagulant, 15, 105, 123 Antigen, 67, 103, 104, 105, 114, 115 Antimicrobial, 66, 105 Anus, 104, 105, 124 Apolipoproteins, 105, 116 Apoptosis, 28, 105, 107 Arachidonic Acid, 105, 122 Arteries, 105, 106, 109, 117, 118 Assay, 7, 67, 105, 115 Atypical, 26, 58, 105 B Bacteria, 104, 105, 111, 114, 118, 128 Bile, 105, 116, 126

Bioavailability, 10, 18, 69, 105 Biochemical, 27, 105 Biological therapy, 105, 113 Biopsy, 6, 106 Biotechnology, 12, 76, 87, 106 Bladder, 106, 108, 123, 128 Blastocyst, 106, 108, 121 Blood Coagulation, 106, 107, 127 Blood pressure, 106, 107, 114 Blood vessel, 104, 106, 107, 125, 126, 128, 129 Bone Density, 8, 106 Bone Marrow, 106, 117, 125, 126 Breast Feeding, 9, 106 Breeding, 11, 106 Buccal, 9, 106 C Caffeine, 62, 106 Calcium, 70, 106, 117 Capsules, 50, 107 Carbohydrate, 17, 22, 107, 122 Carcinogenic, 107, 115, 126 Carcinoma, 39, 107, 109 Cardiac, 106, 107, 119, 126 Cardiovascular, 70, 107 Cardiovascular disease, 70, 107 Case report, 29, 30, 37, 40, 107, 108 Case series, 107, 108 Caspase, 17, 107 Cell Aggregation, 107, 119 Cell Death, 105, 107, 119 Cell Division, 105, 107, 113, 118, 121 Cell Survival, 107, 113 Central Nervous System, 106, 107, 113, 116 Cerebrovascular, 107 Cervical, 5, 19, 30, 68, 107 Cervix, 103, 107 Cholesterol, 70, 105, 108, 109, 113, 116, 117, 126, 127 Cholesterol Esters, 108, 116 Chromatin, 105, 108, 126 Chronic, 108, 111, 115, 121, 127 Chronic renal, 108, 121 Chylomicrons, 108, 116 Climacteric, 27, 29, 30, 108 Clinical study, 16, 36, 108

132

Levonorgestrel

Clinical trial, 3, 21, 37, 41, 87, 108, 109, 110, 119, 124 Cloning, 106, 108 Collagen, 104, 108, 112, 117 Compliance, 4, 5, 8, 108 Computational Biology, 87, 108 Conception, 4, 68, 103, 108, 109, 112, 126 Concomitant, 26, 108 Connective Tissue, 106, 108, 110, 117, 126 Contraceptive Agents, 14, 50, 109, 110 Contraindications, ii, 109 Controlled study, 6, 13, 109 Coronary, 70, 107, 109, 114, 118 Coronary heart disease, 70, 107, 109, 114 Coronary Thrombosis, 109, 118 Corpus, 109, 122 Corpus Luteum, 109, 122 Cortex, 109 Curative, 109, 127 Cyclic, 106, 109 Cyproterone, 24, 51, 53, 109 Cyproterone Acetate, 53, 109 Cyst, 22, 109 Cysteine, 9, 66, 109 Cystine, 109 Cytokines, 5, 109 Cytoplasm, 105, 109, 124 D Decidua, 109, 118, 121 Deletion, 105, 110 Density, 13, 22, 24, 56, 106, 110, 116, 119 Dermis, 110, 128 Desogestrel, 13, 15, 18, 22, 24, 25, 28, 48, 51, 52, 110 Diagnostic procedure, 65, 76, 110 Dialyzer, 110, 113 Digestion, 104, 105, 110, 116, 126 Dihydrotestosterone, 21, 109, 110 Direct, iii, 67, 79, 110, 124 Dissociation, 103, 110 Diuresis, 106, 110 Double-blind, 6, 13, 15, 25, 52, 53, 110 Drug Delivery Systems, 66, 110 Drug Interactions, 80, 110 Drug Tolerance, 110, 127 Dysmenorrhea, 7, 14, 110 E Efficacy, 5, 8, 13, 14, 28, 29, 38, 41, 42, 52, 68, 110 Electrophoresis, 103, 110 Embryo, 103, 106, 111, 115, 119 Endocrine System, 111

Endocrinology, 11, 21, 24, 36, 37, 57, 111 Endogenous, 25, 111, 118, 123 Endometrial, 5, 6, 13, 16, 19, 29, 30, 34, 35, 36, 39, 42, 43, 48, 52, 54, 56, 58, 111 Endometrium, 5, 6, 10, 17, 27, 28, 30, 33, 34, 35, 41, 42, 48, 50, 52, 55, 58, 68, 109, 111, 118 Endotoxic, 111, 116 End-stage renal, 108, 111, 121 Enhancer, 66, 111 Environmental Health, 86, 88, 111 Enzymatic, 104, 107, 111 Enzyme, 67, 107, 111, 118, 121, 127, 129 Epidemiological, 54, 111 Estradiol, 13, 14, 18, 19, 24, 26, 27, 28, 29, 30, 35, 36, 45, 46, 52, 54, 55, 59, 62, 67, 69, 70, 111 Estrogen, 6, 13, 24, 33, 53, 56, 67, 68, 69, 70, 109, 111, 125, 127 Estrogen receptor, 6, 24, 56, 111 Ethinyl Estradiol, 8, 14, 16, 17, 22, 24, 25, 27, 28, 31, 35, 40, 44, 45, 54, 55, 67, 111 Excipient, 5, 111 Exogenous, 11, 111, 123 Extracellular, 108, 111, 117 Extracellular Matrix, 108, 111, 117 Extracellular Matrix Proteins, 111, 117 F Family Planning, 20, 29, 30, 31, 39, 43, 57, 87, 112 Fat, 9, 57, 105, 106, 109, 112, 116, 128 Fetus, 103, 112, 121, 122, 128 Fibrinogen, 112, 121, 127 Follicular Phase, 5, 112 G Gastric, 112, 119 Gastric Acid, 112, 119 Gastrin, 112, 114 Gels, 112, 118 Gene, 9, 106, 112, 114 Germ Cells, 112, 120, 125, 126, 127 Gestation, 26, 112, 121 Gland, 103, 112, 117, 120, 123, 125 Glucocorticoid, 112, 118 Glucose, 15, 112, 115, 124 Glycine, 66, 104, 112, 119 Gonadal, 112, 126 Gonadorelin, 112, 116 Gonadotropin, 11, 14, 112, 116 Governing Board, 113, 122 Grade, 69, 113 Grafting, 113, 115

133

Gravis, 42, 113 Growth factors, 35, 55, 113 H Haemorrhage, 103, 113 Half-Life, 5, 113 Haptens, 103, 113 Headache, 106, 113 Heart attack, 107, 113 Hemodialysis, 38, 110, 113 Hemostasis, 15, 113 Heredity, 112, 113 Herpes, 4, 113 Herpes Zoster, 113 Heterogeneity, 103, 113 High-density lipoproteins, 70, 113 Hirsutism, 109, 114 Histology, 11, 52, 114 Homogeneous, 50, 114 Homologous, 66, 114 Hormonal, 4, 11, 21, 27, 28, 33, 46, 114 Hormonal therapy, 11, 114 Hormone Replacement Therapy, 13, 26, 36, 46, 55, 62, 70, 92, 114 Hormone therapy, 114 Human growth hormone, 24, 114 Human papillomavirus, 5, 114 Hydration, 103, 114 Hydrogen, 107, 111, 114, 118, 120 Hydrophobic, 114, 116 Hydroxyproline, 104, 108, 114 Hyperplasia, 39, 43, 58, 114 Hypertension, 107, 113, 114 Hypertrophy, 114 Hysterectomy, 12, 20, 22, 39, 44, 49, 58, 114 I Idiopathic, 49, 58, 114 Immune response, 103, 105, 113, 114, 115, 127, 129 Immunoassay, 11, 115 Immunogenic, 115, 116 Immunohistochemistry, 11, 115 Immunologic, 115 Immunology, 103, 115 Implantation, 5, 68, 108, 115, 119 In situ, 7, 115 In vitro, 4, 7, 10, 56, 107, 115 In vivo, 6, 7, 115 Induction, 5, 11, 34, 115, 120 Infarction, 109, 115, 118 Infection, 4, 105, 115, 117, 127, 129 Infertility, 11, 115

Inflammation, 103, 113, 115, 121, 123 Initiation, 9, 115 Inorganic, 115, 119 Insulin, 15, 24, 35, 42, 70, 115, 116 Insulin-dependent diabetes mellitus, 115 Insulin-like, 24, 35, 42, 116 Intermittent, 10, 116 Intoxication, 116, 129 Intracellular, 106, 115, 116 Intramuscular, 36, 116, 120 Intravenous, 116, 120 Intrinsic, 56, 103, 116 K Kb, 86, 116 Kinetics, 62, 116 L Lactation, 27, 31, 116, 119 Laparoscopy, 11, 116 Large Intestine, 116, 124, 125 Lesion, 7, 116 Leukocytes, 106, 109, 116 Leuprolide, 11, 116 Levodopa, 116, 125 Ligaments, 109, 116 Lipid, 27, 36, 70, 105, 115, 116, 128 Lipid A, 36, 70, 116 Lipopolysaccharides, 116 Lipoprotein, 22, 25, 36, 70, 116, 117 Liver, 69, 105, 113, 116, 118 Lobe, 114, 116, 120 Localization, 115, 116 Localized, 114, 115, 117, 118, 121 Longitudinal study, 4, 117 Low-density lipoprotein, 70, 116, 117 Luteal Phase, 117, 118 Lymph, 107, 117 Lymph node, 107, 117 Lymphatic, 115, 117, 125 Lymphocyte, 105, 117 M Mammary, 117, 127 Manifest, 57, 117 Matrix metalloproteinase, 5, 19, 30, 50, 117 MEDLINE, 87, 117 Medroxyprogesterone, 24, 27, 43, 117 Medroxyprogesterone Acetate, 24, 27, 117 Membrane, 110, 111, 117, 119, 121, 122, 124 Menopause, 29, 30, 52, 70, 117, 119, 120, 122 Menorrhagia, 15, 19, 20, 22, 29, 34, 39, 49, 54, 55, 56, 57, 58, 76, 117

134

Levonorgestrel

Menstruation, 104, 110, 112, 117 Mental, iv, 3, 86, 88, 110, 117, 123, 124 Meta-Analysis, 51, 118 Metastasis, 117, 118 MI, 101, 118 Microbicide, 4, 118 Microbiology, 105, 118 Microgram, 15, 38, 118 Microorganism, 118, 129 Mifepristone, 6, 10, 26, 29, 40, 44, 51, 75, 118 Milligram, 118 Milliliter, 106, 118 Mitosis, 105, 118 Modification, 8, 33, 104, 118 Molecular, 5, 7, 26, 30, 34, 42, 56, 66, 87, 89, 106, 108, 112, 118, 121, 128 Molecule, 105, 110, 118, 124 Monoamine, 118, 125 Monoamine Oxidase, 118, 125 Morphology, 56, 119 Mucosa, 119, 126 Mucus, 5, 68, 119 Multicenter study, 32, 119 Myocardium, 118, 119 N Necrosis, 105, 115, 118, 119 Neurotransmitter, 103, 104, 112, 119, 127 Neutrophil, 5, 119 Norgestrel, 119 Nucleus, 103, 105, 108, 109, 119, 126 Nulliparous, 15, 20, 119 O Oestrogen, 36, 53, 119 Omeprazole, 55, 119 Opacity, 110, 119 Osteoporosis, 56, 119 Ovarian Follicle, 35, 47, 109, 119 Ovary, 11, 104, 109, 111, 119, 120, 126 Ovulation, 5, 6, 11, 13, 18, 35, 45, 68, 112, 117, 119, 120 Ovulation Induction, 11, 120 Ovum, 103, 109, 112, 119, 120, 122, 129 P Palliative, 109, 119, 120, 127 Pancreas, 115, 120 Papillomavirus, 120 Paradoxical, 6, 120 Parenteral, 7, 120 Parietal, 119, 120 Patch, 11, 28, 30, 70, 120, 128 Pathologic, 7, 105, 106, 109, 120

Pathologic Processes, 105, 120 Patient Satisfaction, 9, 39, 120 Pelvic, 8, 120, 123 Pelvic inflammatory disease, 9, 120 Pelvis, 120, 128 Peptide, 104, 120, 122, 123 Perception, 8, 120, 125 Perforation, 60, 120 Perimenopausal, 30, 36, 53, 120 PH, 30, 106, 120 Pharmacodynamic, 46, 121 Pharmacokinetic, 5, 14, 40, 46, 121 Pharmacologic, 113, 121, 128 Phospholipids, 112, 116, 121 Phosphorus, 107, 121 Physiologic, 104, 108, 113, 117, 121, 124 Physiology, 111, 121 Pilot study, 6, 14, 15, 22, 23, 30, 46, 121 Placenta, 111, 121, 122 Plants, 106, 112, 119, 121, 124, 128 Plasma, 9, 18, 25, 52, 104, 108, 112, 113, 121 Plasmin, 121 Plasminogen, 34, 121 Plasminogen Activators, 121 Pneumonia, 109, 121 Polycystic, 70, 121 Polymers, 7, 122, 123 Polyp, 29, 122 Polypeptide, 104, 108, 112, 121, 122, 129 Polysaccharide, 4, 105, 122 Postmenopausal, 9, 19, 27, 30, 35, 36, 46, 52, 53, 54, 56, 119, 122 Postmenopause, 53, 122 Practice Guidelines, 88, 122 Precursor, 104, 105, 111, 116, 121, 122 Premenopausal, 9, 122 Prenatal, 9, 111, 122 Prenatal Care, 9, 122 Prevalence, 8, 47, 122 Progesterone, 6, 21, 24, 27, 45, 46, 52, 118, 119, 122, 126 Progestogen, 5, 11, 15, 33, 122 Progression, 104, 122, 125 Prospective study, 15, 23, 117, 122 Prostaglandins, 8, 105, 118, 122, 123 Prostaglandins A, 8, 122 Prostaglandins D, 123 Prostaglandins F, 118, 123 Prostate, 119, 123 Protein Binding, 47, 53, 123 Protein C, 67, 105, 116, 123

135

Protein S, 48, 106, 114, 123, 124 Proteins, 35, 104, 105, 107, 108, 109, 111, 117, 118, 120, 121, 122, 123, 125, 128 Psychic, 19, 108, 117, 123 Psychoactive, 123, 129 Public Policy, 87, 123 Publishing, 12, 123 R Race, 119, 123 Racemic, 119, 123 Radioactive, 113, 114, 115, 123 Random Allocation, 123 Randomization, 9, 123 Randomized, 6, 8, 9, 10, 13, 14, 15, 16, 20, 24, 25, 28, 36, 48, 49, 52, 110, 124 Randomized clinical trial, 36, 49, 124 Receptor, 6, 21, 48, 105, 109, 118, 124 Rectal, 4, 124 Rectum, 105, 116, 123, 124, 127 Refer, 1, 106, 113, 116, 124, 128 Refractory, 48, 124 Regimen, 30, 38, 41, 51, 57, 76, 110, 124 Retina, 124 Retrospective, 16, 124 Reverse Transcriptase Polymerase Chain Reaction, 11, 124 Ribosome, 124, 128 Risk factor, 70, 122, 124 Rod, 20, 23, 31, 57, 73, 76, 124 S Saponins, 124, 126 Schizoid, 124, 129 Schizophrenia, 124, 125, 129 Schizotypal Personality Disorder, 124, 129 Screening, 108, 125 Secretion, 24, 112, 115, 116, 119, 125 Secretory, 119, 125 Selective estrogen receptor modulator, 125, 127 Selegiline, 26, 125 Seminiferous tubule, 125, 126 Semisynthetic, 111, 125 Senile, 119, 125 Serologic, 115, 125 Serum, 24, 27, 28, 45, 47, 52, 53, 67, 113, 117, 125 Sex Characteristics, 103, 119, 125, 127 Side effect, 7, 8, 10, 41, 45, 66, 68, 79, 103, 105, 125, 128 Skull, 125, 127 Small intestine, 108, 114, 125 Smooth muscle, 106, 123, 125, 127

Solid tumor, 104, 125 Solvent, 66, 125 Soma, 125 Somatic, 19, 103, 108, 118, 125 Specialist, 93, 126 Species, 11, 18, 118, 123, 126, 127, 129 Specificity, 103, 126 Sperm, 5, 56, 68, 103, 125, 126 Sperm Head, 103, 126 Spermatogenesis, 14, 21, 33, 126 Spermatozoa, 56, 103, 126 Spermatozoon, 103, 126 Spinal cord, 107, 108, 126 Spotting, 5, 68, 126 Steady state, 48, 126 Steel, 58, 126 Sterility, 13, 14, 16, 19, 22, 27, 29, 30, 32, 34, 35, 40, 44, 45, 58, 59, 115, 126 Sterilization, 52, 126 Steroid, 18, 26, 30, 53, 56, 67, 68, 69, 104, 119, 124, 126 Stimulant, 106, 126 Stomach, 112, 114, 125, 126 Stroke, 86, 107, 126 Stromal, 48, 126 Stromal Cells, 48, 126 Subacute, 115, 127 Subclinical, 115, 127 Subcutaneous, 7, 10, 21, 120, 127 Subspecies, 126, 127 Substance P, 122, 125, 127 Suppositories, 118, 127 Suppression, 10, 21, 30, 33, 68, 127 Suppressive, 10, 127 Symptomatic, 22, 127 Systemic, 5, 41, 43, 55, 66, 80, 106, 115, 127 T Tamoxifen, 29, 39, 76, 125, 127 Temporal, 10, 127 Testis, 104, 111, 119, 127 Testosterone, 7, 14, 18, 21, 33, 36, 37, 47, 52, 57, 104, 127 Therapeutics, 34, 35, 58, 81, 119, 127 Thermal, 15, 22, 110, 127 Thrombin, 112, 123, 127 Thrombolytic, 121, 127 Thrombomodulin, 123, 127 Tolerance, 38, 127 Tomography, 106, 127 Topical, 66, 128 Toxic, iv, 69, 128 Toxicity, 110, 128

136

Levonorgestrel

Toxicology, 16, 51, 88, 128 Toxin, 111, 127, 128 Transcutaneous, 68, 128 Transdermal, 10, 13, 21, 28, 29, 30, 35, 37, 52, 53, 54, 66, 68, 69, 70, 128 Transfection, 106, 128 Translation, 10, 104, 128 Triglyceride, 70, 128 U Urethra, 123, 128 Urinary, 24, 27, 128 Urine, 6, 9, 106, 110, 128 Uterine Contraction, 103, 128 Uterine Perforation, 36, 128 Uterus, 7, 11, 40, 68, 103, 107, 109, 110, 111, 114, 117, 122, 128 V Vaccines, 128, 129 Vagina, 107, 117, 126, 128 Vaginal, 4, 13, 18, 19, 22, 42, 46, 50, 54, 128 Vascular, 27, 110, 115, 119, 121, 128

Vascular endothelial growth factor, 27, 128 Vasoactive, 27, 128 Vasomotor, 52, 129 Veins, 106, 129 Venous, 12, 51, 123, 129 Veterinary Medicine, 87, 129 Virus, 4, 111, 114, 129 Viscera, 125, 129 Vitro, 5, 7, 129 Vivo, 7, 129 W Warts, 114, 129 White blood cell, 104, 116, 117, 119, 129 Withdrawal, 68, 129 Womb, 128, 129 Wound Healing, 117, 129 X Xenograft, 104, 129 X-ray, 106, 129 Z Zygote, 108, 129 Zymogen, 123, 129

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