Generic Plan B

LEVONORGESTREL
Trade Names: Biphasil, Levlen ED, Logynon ED, Microgynon, Microlut, Microval, Monofeme 28, Nordette, Nordiol, Sequilar ED, Trifeme 28, Triphasil, Triquilar
How Available: tablet
Drug Group: Oral contraceptive
Prescription: Yes
Major Uses: This medication is similar to a naturally occurring female sex hormone (progesterone). It is used in many types of oral contraceptive pills, either alone (the progesterone only or 'mini-pill') or in combination with oestrogen in the more commonly prescribed combined pill. It is also used in combination with oestrogen in women taking these hormones as a replacement at and after the menopause.
How it Works: If used alone, levonorgestrel may act by changing the nature of the mucus around the cervix, preventing sperm from fertilizing the ovum. In combination with oestrogen it prevents the release of hormones which stimulate the ovary, so no ova are released.
Usual Dosage: 30 micrograms is the dose of levonorgestrel in progesterone only pills. It is important that the dose be taken at the same time every day to achieve effective contraception. The dose is considerably higher (75-250 micrograms) with the combined pill.
Common Side-Effects: Change in menstrual periods and irregular menstrual bleeding are common side-effects if the medication is used alone. Weight gain and swollen ankles are also common. Nausea and vomiting are possible. Many other side-effects have been reported with this medication when combined with oestrogen.
Actions with other Drugs: Many antibiotics can interfere with levonorgestrel absorption and cause irregular menstrual bleeding and, possibly, contraceptive failure. Also, this medication can adversely affect the action of blood glucose lowering drugs, some anticonvulsants, blood pressure lowering drugs and anti-coagulants. It is important to let your doctor know if you are taking any other medications.
Pregnancy, Breastfeeding: Levonorgestrel is used in women who are breastfeeding and need contraception. Small amounts of levonorgestrel do pass into the breast milk, but have not been shown to cause problems.
Special Features, Comments: Most women use levonorgestrel alone and in combination with oestrogen for many years with minimal problems.
WOMEN’S HEALTH

PHYSICAL ACTIVITY PRESCRIPTION DURING PREGNANCY
Healthy pregnant women can begin or maintain moderate intensity physical activity with potentially minimal negative effects. Activity guidelines must be flexible and individualized, and regular monitoring of the woman and her fetus is required.
Three don'ts to share with your patients:
- Don't get exhausted. Take plenty of rest.
- Don't overheat. Avoid humid and hot temperatures.
- Don't dehydrate. Drink plenty of water.
When starting a physical activity program in a previously inactive woman, wait until the second trimester to allow closure of the neural tube. Prescribe non-weight-bearing activities such as walking, low-impact aerobics, and water sports. For women who are already fit, physical activity can be continued at the pre-pregnancy activity level during the first and second trimesters, but it should not exceed 20-40 min/day and should not be at an intense level. After the 29th week, decrease exercise intensity, duration, and frequency slightly, and exercise after meals to avoid hypoglycemia.
Even fit women should avoid scuba diving, hiking at high altitudes, activities that involve high-risk positions and/or extreme jerking motions, and situations where loss of balance would endanger the mother and fetus. All women should avoid prolonged physical activity in a supine position after the fourth month of pregnancy, when the weight of a pregnant uterus impedes adequate venous return. In general, conservative approaches are best, and common sense must prevail.
The intensity of physical activity should be low-to-moderate. Since heart rate is naturally elevated during pregnancy, it cannot be used alone as a reliable monitoring tool for intensity. Rate of perceived exertion is probably a better tool because it is the least affected by gestational adaptations. Also, the "talk test" can be used as a good measure to monitor intensity during pregnancy. The duration of physical activity depends on the pre-pregnant maternal state of fitness, the stage of gestation, exercise modality used, intensity, environmental conditions, and the maternal response to physical activity. A reasonable exercise period at moderate intensity is 20 - 40 minutes; this includes warm-up and cool-down time. A regular routine (3-5 times per week is ideal) with shorter durations (20 minutes) is preferred to sporadic episodes of longer durations.
Pregnant women should continually monitor how they feel while exercising, and should cease exercise immediately if any symptoms of excessive fatigue, pain, bleeding, gushing vaginal fluid, dizziness, shortness of breath, palpations, faintness, tachycardia, back pain, pubic pain, difficulty walking, decreased fetal movement, or persistent contractions occur or have occurred in the pregnancy. Regular medical monitoring by the physician is essential, as the effect of physical activity on the pregnancy can change throughout gestation. Monitoring the exercise program includes assessing for: sufficient weight gain, increasing symphysis fundal heights according to gestation, and fetal wellness by ultrasound.
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WOMEN’S HEALTH

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