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INTRODUCTION

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Drugs to control fertility and treat disorders of the female reproductive organs collectively are among the most frequently prescribed agents in clinical practice. This chapter discusses a number of common clinical issues and their drug therapies that are central to women's health. The focus is on reproductive disorders and aspects of therapy rather than comprehensive coverage of the drugs themselves, which are described in more detail elsewhere (e.g., see Chapter 33 for prostaglandins; Chapter 38 for the gonadotropins, gonadotropin-releasing hormone [GnRH] agonists and antagonists, and oxytocin; Chapter 40 for estrogens and progestins; Section VII for antibiotics).

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CONTRACEPTION

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Contraception can be administered as planned prophylaxis or postcoitally for emergency contraception (i.e., high-dose estrogen-containing oral contraceptive pills, high-dose progestin pills, a progesterone antagonist, intrauterine devices). A progesterone antagonist also can be used to terminate an established pregnancy.

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PLANNED CONTRACEPTION

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COMBINATION ORAL CONTRACEPTIVES. Pills containing an estrogen and progestin are the most widely used (Table 66–1); they act primarily by suppressing the luteinizing hormone (LH) surge and thereby preventing ovulation. A wide variety of preparations are available for oral, transdermal, and vaginal administration (see Table 66–2 in the 12th edition of the parent text for a list of branded formulations, many of which are available as generics). Almost all contain ethinyl estradiol as the estrogen and a 17α-alkyl-19-nortestosterone derivative as the progestin, and are administered for the first 21-24 days of a 28-day cycle.

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Table Graphic Jump Location
Table 66–1One-Year Failure Rate with Various Forms of Contraception
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Table Graphic Jump Location
Table 66–2Sexually Transmitted Gynecological Infections and Recommended Therapies

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