{"paper_id":"4b4724ce-b0f5-4da1-84c6-3dea798225fe","body_text":"Effects of Different Progesterone Containing Contraceptive Methods on Safety and Endogenous Progesterone Level | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Different Progesterone Containing Contraceptive Methods on Safety and Endogenous Progesterone Level Ahmed Ossman, Mona Omar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1644574/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background: Progestogen-only’ contraceptives are presented as injections, implants, oral formulations, hormone-releasing intrauterine methods, and emergency contraceptives. The research designed to assess the effect of different progesterone containing contraceptive methods on safety and endogenous progesterone level. Methods: This prospective cohort study was involved 80 healthy fertile females aged 20-35 years with normal menstrual history and had at least one offspring after spontaneous pregnancy. Subjects were classified into four equal groups according to contraceptive method: group D(Depo-Provera®): used the injectable progesterone of 150 mg every 90 days or 3 months, group I: contains 68 mg of etonogestrel implant formerly known as Implanon, group N: used norgestrel (Ovrette®), (each pill containing 0.075 mg of norgestrel) once daily, and group M: used IUD (Mirena) containing 52 mg of levonorgestrel. Results: Group M had higher endogenous progesterone level compared to those who used other contraceptives containing with normal follicle size. Incidence of amenorrhea was significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference among the other three groups. Continuation rate was significantly higher in group M than other three groups after 6 months. Efficacy was insignificantly different among the four groups. Conclusion: Mirena had low systemic absorption of exogenous progesterone so, it had less effect on endogenous progesterone with better follicle size and low incidence of side effects (amenorrhea) compared to other contraceptives containing progesterone. Endogenous Progesterone Level Depo-Provera Implanon Oral Mirena Figures Figure 1 Figure 2 Figure 3 Introduction Progestogen-only’ contraceptives are presented as injections, implants, oral formulations, hormone-releasing intrauterine methods and emergency contraceptives [1] . These substances could be used by females who are breastfeeding or have other contraindications to estrogen treatment, including those who are immediately postpartum, have thalassemia, sickle-cell disease, gallbladder disease, or currently experiencing thrombo-embolic disorders, valvular heart disease, ischemic heart disease [2] . Intrauterine, injectable methods and contraceptive implants named as long-acting reversible contraceptives (LARC) are the more efficient reversible contraceptive approaches are highly effective, longer-acting contraceptive methods levels [3] . Depot medroxyprogesterone acetate (Depo-Provera®) is an injectable progestogen that is given in an aqueous microcrystalline solution via deep intramuscular injection into the gluteal or deltoid muscle [4] . It is administered once every 90 days at a dose of 150 mg [5] . It has side effects as menstrual disturbances that might manifest as amenorrhea or regular and/or irregular bleeding ,and weight increase as a familiar adverse-effect [6] . Subdermal implants release progestogen gradually over an extended time and give reversible, long-term contraception [7] . Nexplanon is an etonogestrel implant that contains 68 mg of etonogestrel, formerly known as Implanon. As the injectable progestogen-only contraceptives, progestogen implants induce amenorrhea or regular or intermittent bleeding in the majority cases [8] . Additionally, implants are more expensive than a variety of alternative approaches [8] . Progesterone only Pill (more commonly preparations have drospirenone or norethindrone). Drospirenone inhibits ovulation and acts as an anti-mineralocorticoid. Certain progestins have more antiandrogenic characteristics, making them more helpful in the treatment of polycystic ovarian syndrome, hirsutism, and acne [9] . It had several side effects as irregular menstruation, breast discomfort, diminished sexual drive (libido), melancholy, headaches, nausea, and ovarian cysts. Levonorgestrel-releasing IUD (Mirena) contains 52 mg of levonorgestrel that is released slowly over time and inserted into the uterus as a small T-shaped device. It is implanted directly into the uterus by a trained healthcare professional [10] . After implantation, Mirena can help prevent pregnancy for up to seven years and decrease menstrual bleeding for up to five years [11] . Mirena may be preferred for women who have heavy menstrual bleeding and want a form of contraception. In addition, Mirena provides protection from pregnancy longer than Nexplanon at seven years versus three years [12] . We hypothesized that Mirena had low systemic absorption with local effect on endometrium and low incidence of amenorrhea, therefore it could be used in females who had problems with using other progesterone containing contraceptive methods. There was a paucity of studies that has directly assessed the endogenous level of progesterone and side effects in different contraceptive containing progesterone among postpartum parous adolescents. Therefore, the purpose of this study was to assess the effect of different progesterone containing contraceptive methods on safety and endogenous progesterone level. Materials And Methods This prospective cohort research involved 80 healthy fertile females aged 20-35 years with normal menstrual history and had at least one offspring after spontaneous pregnancy. The study was done after approval from the Ethical Committee of Faculty of Medicine at Obstetrics and Gynecology department in Tanta University Hospital, Egypt between March 2021 to March 2022. All participants provided informed written consent. Exclusion criteria were any disease affects uterus (uterine tumors fibroids, endometriosis, prolapse, or tuberculosis), ovarian tumors, submucous myoma, irregular menstrual cycle, past or family history of breast disease ,thyroid, DVT, migraine, diabetic patients ,medication affecting reproductive or metabolic functions and an endometrial thickness <7 mm on the secretory transformation day, a history of spontaneous abortions or embryo transfer failure on over three occasions, patients had cortisol medications, and patients who received radiological treatment. Subjects were classified into four equal groups according to contraceptive method: group D(Depo-Provera®): used the injectable progesterone of 150 mg every 90 days or 3 months, group I: contains 68 mg of etonogestrel implant formerly known as Implanon, group N: used norgestrel (Ovrette®), (each pill containing 0.075 mg of norgestrel) once daily, and group M: used IUD (Mirena) containing 52 mg of levonorgestrel. All women were subjected to : Detailed history menstrual pattern, fertility status, any previous investigations or treatment given, with a special stress on type and method of contraception, clinical examination as heart rate and blood pressure and laboratory investigation . Endogenous progesterone measurement was performed in all groups at 21 days of cycle every month till for 6 months, ovulation (follicular size) and endometrium thickness every month for 6 months .Side effects as (amenorrhea and irregular bleeding) were recorded. Efficacy and continuation rate of different contraceptive methods were recorded. Serum sample preparation Blood samples were collected from cases into serum tubes which did not contain anti-coagulant and leave to clot for 30 minutes at room temperature. Centrifugation was used to separate serum, and samples were kept at -80°C until analysis. After defrosting the serum samples on ice, 0.5 mL of serum was transferred to a 10 mL glass centrifuge tube. Every serum sample was spiked with 10 μL of internal standard, 1 mL 100 mM potassium phosphate, pH 9-, and 4-mL pentane was added. The samples were transported into injection vials for analysis by liquid chromatography-mass spectrometry (LC/MS/MS). Ultrasound for endometrium thickness The endometrium was measured by ultrasound in the long axis or sagittal plane, ideally on transvaginal scanning, with the entirety of the endometrial lining through to the endocervical canal in view. The thickness of the echogenic area from one endometrial base across the endometrial canal to the other endometrial base was measured. Sample size calculation G. power 3.1.9.2 was used to calculate the sample size (Universitat Kiel, Germany). The sample size was based on the following: 0.05 α error and 90% power, allocation ratio 1:1 to demonstrate the incidence of amenorrhea with Mirena 20% [13] versus Depo-Provera (75%) [14] according to previous studies. three cases were added to overcome dropout. As a result, twenty patients were recruited in each group. Our outcomes were the incidence of side effects, endogenous progesterone level, and ovulation. Statistical analysis SPSS version 26 was used for statistical analysis (IBM Inc., Chicago, IL, USA). The mean and standard deviation (SD) of quantitative variables were calculated and compared using the ANOVA test with post hoc (Tukey) test. The frequency and percentage values of qualitative variables were evaluated statistically using the Chi-square test. Statistical significance was defined as a two-tailed P value of 0.05. Results We included 80patients, 20 patients in groupd,20 patients in group I, 20 patients in group and 20patients in group M. Figure 1 Demographic data, menstrual cycle, parity, and mode of delivery were comparable among the four groups. Table1 Endogenous progesterone level was significantly higher in group M than other three groups at 1 st month till 6 th month of measurements (P =0.001), while there was an insignificant difference among the other three groups. There was an insignificant difference among the four groups at baseline measurement. Table 2 Follicle size was significantly higher in group M than other three groups (P =0.001) and there was an insignificant difference among the other three groups. Figure 2 Amenorrhea was significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference among the other three groups. Irregular bleeding was insignificantly different among the four groups. Table 4 Continuation rate was noticeably higher in group M than other three groups after 6 months while there was an insignificant difference among other three groups. Unintended pregnancies were insignificantly different among the four studied groups. Table 5 Endometrium thickness was insignificantly different among the four groups at 1 st month till 6 th month. Figure 3 Discussion LARCs are increasingly prevalent among females looking for contraception [15] . Progestogens are the primary active ingredient in hormonal contraception, as they have essentially three modes of action, their structure and the action profile are different, they show a multifocal form of action in contraception. Moreover, the normal progestogenic effect, each progestogen has a partial effect pattern, and different effects on endogenous progesterone and ovulation rate with different side effects [16] . In our study, Mirena had higher endogenous progesterone level compared to the other contraceptives containing progesterone (oral, Implanon and injectable progesterone), this may be due to the high systemic absorption of exogenous progesterone from other methods while Mirena had low systemic absorption of progesterone. Also, women who used Mirena had normal follicle size compared to other three groups but other three groups had low follicle size. Barbosa et al. [17] studied the effect of IUD on ovarian function and found that the dose of levonorgestrel delivered from the IUD is low, it probably exerts an effect on the gonadotrophin secretion, which disturbs follicular development in many of the studied women, as well as its local effect on the endometrium, contributes to its high contraceptive efficacy. In current research, endometrium thickness was significantly lower in the four contraceptive methods <8mm. In Yang et al [18] , reported that the endometrial thickness, menstrual time in the group who had Mirena were better than those in the control group when they evaluated of the efficacy of Mirena combined with hysteroscopic surgery. Amenorrhea was significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference among the other three groups. Irregular bleeding was insignificantly different among the four groups. Consistent with our findings, Pedro et al, found that incidence of amenorrhea with women who had used Mirena was 13% while in women who had used Depo Provera was 75%. Also, in Sergison et al. [19] who showed prevalence of amenorrhea with IUD and found that, 18.2% of participants underwent amenorrhea for at least 90-day interval throughout the 1 st year. In previous clinical study [20] most women who used Depo Provera have experienced menstrual irregularities with continues use ,amenorrhea becomes common, reported by 57% of the women after a year of usage. In our study incidence of irregular bleeding was 80% with group D, 65% with group I 70% with N group and 45% with M group. In Regidor et al, [21] found that incidence of irregular bleeding with women who had used Mirena was (50%) while in women who had used Depo Provera was (75%). Wong et al. [22] found that 4.5% of the IUD users reported abnormal bleeding as their reason for discontinuation. Similarly, Teal et al. [23] found that 8% of the adolescent IUD users in their study reported abnormal bleeding as their reason for discontinuation. These studies and ours provide evidence that unsatisfactory bleeding with IUDs tends to be less common than unsatisfactory bleeding with Depo-Provera. Moreover, Howard et al. [24] found that only 16% of Mirena users found the unpredictability of their bleeding unacceptable at 6 months of follow-up, when compared between Mirena and Depo-Provera. Continuation rate was notably greater in group M than other three groups after 6 months while there was an insignificant difference among the four studied groups. Efficacy of the different contraceptive method was comparable among four studied groups. Moreau et al, [25] using data from the National Survey of Family Growth found that 33.7% of women who discontinued Depo-Provera reported that dislike of the changes in menstrual periods was their reason for discontinuation. In Peipert et al., [26] who studied maintenance and satisfaction of reversible contraception and found that the highest rate of continuation was with LNG-IUS (88%). Compared to other reversible methods, the LNG-IUS is among the most effective with a failure rate of 0.1% in the first year – like or even better than female sterilization Our study had certain limitation as single center study with insufficient sample size, follow-up period is brief and absence of randomization as participants were not assigned a contraceptive technique at random, their expectations of a contraceptive method may be different from the outset. We did not believe that randomizing patients to a method of contraception was ethical, and that randomization could have a negative effect on continuance, which was one of our outcomes. Conclusion Mirena had low systemic absorption of exogenous progesterone so, it had less effect on endogenous progesterone with better follicle size and low incidence of side effects (amenorrhea) compared to other contraceptives containing progesterone. Therefore, Mirena is an effective and safe contraceptive method that can be used with women who had complication with using progesterone containing contraceptive methods. References 1. Regidor P-A. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38. 2. De Sanctis V, Soliman AT, Daar S, Canatan D, Di Maio S, Kattamis C. Current Issues and Options for Hormonal Contraception in Adolescents and Young Adult Women With Sickle Cell Disease: An Update for Health Care Professionals. Mediterranean journal of hematology and infectious diseases. 2020;12:13-1. 3. Jacobstein R, Polis CB. Progestin-only contraception: Injectables and implants. Best Pract Res Clin Obstet Gynaecol. 2014;28:795-806. 4. Ma Z, Zhang H, Wang Y, Tang X. Development and evaluation of intramuscularly administered nano/microcrystal suspension. Expert Opin Drug Deliv. 2019;16:347-61. 5. Bruni V, Dei M, Pampaloni F. Hormonal contraception. Female Reproductive Dysfunction. 2020:123-52. 6. Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. Open Access J Contracept. 2016;7:43-52. 7. Rocca ML, Palumbo AR, Visconti F, Di Carlo C. Safety and benefits of contraceptives implants: A systematic review. Pharmaceuticals (Basel, Switzerland). 2021;14:548. 8. Moray KV, Chaurasia H, Sachin O, Joshi B. A Systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18:1-24. 9. Powell A. Choosing the right oral contraceptive pill for teens. Pediatr Clin North Am. 2017;64:343-58. 10. Ingle S, Tegeli V, Javalgikar A, Matole V, Koli L, Birajdar A, et al. A Brief review on intra-uterine drug delivery systems. RJPDFT. 2021;13:72-5. 11. Bao Q, Gu B, Price CF, Zou Y, Wang Y, Kozak D, et al. Manufacturing and characterization of long-acting levonorgestrel intrauterine systems. International journal of pharmaceutics. 2018;550:447-54. 12. Boog K, Cooper M. Long acting reversible contraception. Obstet Gynaecol Reprod Med 2021;31:185-91. 13. Sergison JE, Maldonado LY, Gao X, Hubacher D. Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. American journal of obstetrics and gynecology. 2019;220:440-8.e8. 14. Regidor P-A. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38. 15. Buckner LR, Drobnis EZ, Augustine MS, Rogers LK, Akers J, Mott PD, et al. Cervical and systemic concentrations of long acting hormonal contraceptive (LARC) progestins depend on delivery method: Implications for the study of HIV transmission. PLoS One. 2019;14:e0214152. 16. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38. 17. Barbosa I, Bakos O, Olsson SE, Odlind V, Johansson ED. Ovarian function during use of a levonorgestrel-releasing IUD. Contraception. 1990;42:51-66. 18. Yang Z, Shao L, Teng Y. Evaluation of the Efficacy and Adverse Reactions of Mirena Combined with Hysteroscopic Surgery When Treating AUB: Based on a Retrospective Cohort Study. Computational and Mathematical Methods in Medicine. 2022;2022:4082266. 19. Sergison JE, Maldonado LY, Gao X, Hubacher D. Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;220:440-8. 20. Sadeghi-Bazargani H, Fardyazar Z. Amenorrhea: an advantage rather than a complication of Depot medroxy progesterone acetate injection contraceptive. International Journal of Pharmacology. 2006;2:352-56. 21. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38. 22. Wong RC, Bell RJ, Thunuguntla K, McNamee K, Vollenhoven B. Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception. 2009;80:452-6. 23. Teal SB, Sheeder J. IUD use in adolescent mothers: retention, failure and reasons for discontinuation. Contraception. 2012;85:270-4. 24. Howard DL, Wayman R, Strickland JL. Satisfaction with and intention to continue Depo-Provera versus the Mirena IUD among post-partum adolescents through 12 months of follow-up. J Pediatr Adolesc Gynecol. 2013;26:358-65. 25. Moreau C, Cleland K, Trussell J. 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Tables Table1: Demographic data among studied groups Group D (n=20) Group I (n=20) Group N (n=20) Group M (n=20) P value Age/years 27.5 ± 5.09 29.35 ± 3.56 26.7±5.18 27.9 ± 4.3 0.325 Weight (Kg) 67.2 ± 7.29 66.4 ± 7.26 64.8 ± 6.99 66.0±7.04 0.757 Height (m) 1.6 ± 0.08 1.6 ± 0.08 1.6 ± 0.08 1.6± 0.09 0.233 BMI(Kg/m 2 ) 27.8 ± 4.42 25.9 ± 3.77 25.52 ± 2.66 25.9 ± 3.86 0.196 Menstrual cycle (days) 28.8 ± 4.18 29.9 ± 4.91 26.4 ± 4.44 27.9 ± 4.32 0.094 Parity Primipara 4 (20%) 3 (15%) 5 (25%) 3 (15%) 0.824 Multipara 16 (80%) 17 (85%) 15 (75%) 17 (85%) Mode of previous delivery Vaginal 7 (35%) 8 (40%) 11 (55%) 9 (45%) 0.619 CS 13 (65%) 12 (60%) 9 (45%) 11 (55%) Data presented as Mean ± SD, CS: caesarian section Table 2: Endogenous progesterone level among studied groups Endogenous progesterone (ng/ml) Group D (n=20) Group I (n=20) Group N (n=20) Group M (n=20) P value Post hoc Baseline 11.10 ±0.91 11.20 ±0.83 10.95 ± 0.89 10.85 ±0.75 0.742 --- 1 st month 1.85±0.88 1.95±0.83 2.2±0.83 11.2±0.83 0.001 P1=0.712 P2=0.203 P3<0.001 P4=0.347 P5<0.001 P6<0.001 2 nd month 2.1±0.79 2±0.79 2.15±0.81 11.15±0.88 0.001 P1=0.692 P2=0.844 P3<0.001 P4=0.559 P5=<0.001 P6=<0.001 3 rd month 2.15±0.75 1.95±0.76 2.05±0.89 10.85±0.88 0.001 P1=0.406 P2=0.702 P3<0.001 P4<0.704 P5<0.001 P6<0.001 4 th month 2.2±0.95 1.9±0.91 2.05±0.76 11.4±1.23 0.001 P1=0.315 P2=0.585 P3<0.001 P4=0.575 P5<0.001 P6<0.001 5 th month 1.4±0.5 1.45±0.51 1.5±0.51 11.35±1.14 0.001 P1=0.757 P2=0.735 P3<0.001 P4=0.759 P5<0.001 P6<0.001 6 th month 1.85±0.88 1.95±0.83 2.2±0.83 11.1±0.79 0.001 P1=0.712 P2=0.203 P3<0.001 P4=0.347 P5<0.001 P6<0.001 Data presented as Mean ± SD, P value= p among four groups, P1=P value between Group D and Group I, P2=P value between Group D and N group, P3=P value between Group D and M group, P4= P value between Group I and N group, P5= P value between Group I and M group, P6= P value between N group and M group. Table 4: Incidence of amenorrhea and irregular bleeding among the studied groups Group D (n=20) Group I (n=20) N group (n=20) M group (n=20) P value Post hoc Amenorrhea 15 (75%) 13 (65%) 14 (70%) 4 (20%) 0.014 P1=0.731 P2=0.731 P3=0.001 P4=1.00 P5=0.015 P6=0.015 Irregular bleeding 16 (80%) 13 (65%) 14 (70%) 9 (45%) 0.126 Data presented as frequency (%), P value= p among four groups ,P1=P value between Group D and Group I,P2=P value between Group D and N group,P3=P value between Group D and M group, P4= P value between Group I and N group,P5= P value between Group I and M group,P6= P value between N group and M group Table 5: Continuation rate and unintended pregnancies among the studied groups Group D Group I N group M group P value Post hoc Continuation rate after 6 months 3 (15%) 7 (35%) 5 (25%) 15 (75%) <0.001 P1= 0.273 P2= 0.694 P3= 0.000 P4=0.730 P5=0.026 P6=0.004 Unintended pregnancies 2 (10%) 1 (5 %) 4 (20%) 1(5%) 0.343 --- Data presented as frequency (%),P value= p among four groups ,P1=P value between Group D and Group I,P2=P value between Group D and N group,P3=P value between Group D and M group, P4= P value between Group I and N group,P5= P value between Group I and M group,P6= P value between N group and M group. Declarations Sponsors and funding sources : Nil Conflict of interests : Nil Acknowledgement: Nil Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-1644574\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":106753548,\"identity\":\"4e15182b-f88d-46f7-8abb-22b9c68d73cd\",\"order_by\":0,\"name\":\"Ahmed Ossman\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Tanta University\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ahmed\",\"middleName\":\"\",\"lastName\":\"Ossman\",\"suffix\":\"\"},{\"id\":106753549,\"identity\":\"09cb8330-9c31-4b84-a8f1-6e9875a7b693\",\"order_by\":1,\"name\":\"Mona Omar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Tanta University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mona\",\"middleName\":\"\",\"lastName\":\"Omar\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-05-11 07:14:22\",\"currentVersionCode\":2,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-1644574/v2\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-1644574/v2\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":25770720,\"identity\":\"5f980e76-9fc8-4b1f-8b81-12b0c0d71911\",\"added_by\":\"auto\",\"created_at\":\"2022-08-29 02:44:07\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":63689,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eSTORBE flow chart among the studied groups\\u003c/strong\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"001.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1644574/v2/7ad77560f9f7b1e41dff9f54.png\"},{\"id\":25770931,\"identity\":\"4a085a97-3266-484e-af35-feaa5a14b4b1\",\"added_by\":\"auto\",\"created_at\":\"2022-08-29 02:49:07\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68655,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFollicle size among the studied groups\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"01.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1644574/v2/08200988f6f2dc1a9dc4d55f.png\"},{\"id\":25770718,\"identity\":\"8529df1b-64f1-44a2-a550-d1a9605b5acc\",\"added_by\":\"auto\",\"created_at\":\"2022-08-29 02:44:07\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":64451,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eEndometrium thickness among the studied groups\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1644574/v2/f5d34a58baff6ad283e8577a.png\"},{\"id\":25770932,\"identity\":\"003304f4-c0be-41e9-8435-e8322a9c3b36\",\"added_by\":\"auto\",\"created_at\":\"2022-08-29 02:49:11\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":657804,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1644574/v2/a7a46ddf-8367-4802-8081-2a425e0510bc.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eEffects of Different Progesterone Containing Contraceptive Methods on Safety and Endogenous Progesterone Level\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eProgestogen-only\\u0026rsquo; contraceptives are presented as injections, implants, oral formulations, hormone-releasing intrauterine methods and emergency contraceptives\\u0026nbsp;\\u003csup\\u003e[1]\\u003c/sup\\u003e. These substances could be used by females who are breastfeeding or have other contraindications to estrogen treatment, including those who are immediately postpartum, have thalassemia, sickle-cell disease, gallbladder disease, or currently experiencing thrombo-embolic disorders, valvular heart disease, ischemic heart disease\\u0026nbsp;\\u003csup\\u003e[2]\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIntrauterine, injectable methods and contraceptive implants named as long-acting reversible contraceptives (LARC) are the more efficient reversible contraceptive approaches are highly effective, longer-acting contraceptive methods levels\\u0026nbsp;\\u003csup\\u003e[3]\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDepot medroxyprogesterone acetate (Depo-Provera\\u0026reg;) is an injectable progestogen that is given in an aqueous microcrystalline solution via deep intramuscular injection into the gluteal or deltoid muscle\\u0026nbsp;\\u003csup\\u003e[4]\\u003c/sup\\u003e. It is administered once every 90 days at a dose of 150 mg\\u0026nbsp;\\u003csup\\u003e[5]\\u003c/sup\\u003e. It has side effects as menstrual disturbances that might manifest as amenorrhea or regular and/or irregular bleeding ,and weight increase as a familiar adverse-effect\\u0026nbsp;\\u003csup\\u003e[6]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eSubdermal implants release progestogen gradually over an extended time and give reversible, long-term contraception\\u0026nbsp;\\u003csup\\u003e[7]\\u003c/sup\\u003e.\\u0026nbsp;Nexplanon is an etonogestrel implant that contains 68 mg of etonogestrel, formerly known as Implanon.\\u0026nbsp;As the injectable progestogen-only contraceptives, progestogen implants induce amenorrhea or regular or intermittent bleeding in the majority cases\\u0026nbsp;\\u003csup\\u003e[8]\\u003c/sup\\u003e. Additionally, implants are more expensive than a variety of alternative approaches\\u0026nbsp;\\u003csup\\u003e[8]\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eProgesterone only Pill (more commonly preparations have drospirenone or norethindrone). Drospirenone inhibits ovulation and acts as an anti-mineralocorticoid. Certain progestins have more antiandrogenic characteristics, making them more helpful in the treatment of polycystic ovarian syndrome, hirsutism, and acne\\u0026nbsp;\\u003csup\\u003e[9]\\u003c/sup\\u003e. It had several side effects as irregular menstruation, breast discomfort, diminished sexual drive (libido), melancholy, headaches, nausea, and ovarian cysts.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eLevonorgestrel-releasing IUD (Mirena) contains 52 mg of levonorgestrel that is released slowly over time and inserted into the uterus as a small T-shaped device. It is implanted directly into the uterus by a trained healthcare professional\\u0026nbsp;\\u003csup\\u003e[10]\\u003c/sup\\u003e. After implantation, Mirena can help prevent pregnancy for up to seven years and decrease menstrual bleeding for up to five years\\u0026nbsp;\\u003csup\\u003e[11]\\u003c/sup\\u003e. Mirena may be preferred for women who have heavy menstrual bleeding and want a form of contraception. In addition, Mirena provides protection from pregnancy longer than Nexplanon at seven years versus three years\\u0026nbsp;\\u003csup\\u003e[12]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eWe hypothesized that Mirena had low systemic absorption with local effect on endometrium and low incidence of amenorrhea, therefore it could be used in females who had problems with using other\\u0026nbsp;progesterone containing contraceptive methods. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThere was a paucity of studies that has directly assessed the endogenous level of progesterone and side effects in different contraceptive containing progesterone among postpartum parous adolescents. Therefore, the purpose of this study was to assess the effect of different progesterone containing contraceptive methods on safety and endogenous progesterone level.\\u003c/p\\u003e\"},{\"header\":\"Materials And Methods\",\"content\":\"\\u003cp\\u003eThis prospective cohort\\u0026nbsp;research\\u0026nbsp;involved\\u0026nbsp;80 healthy fertile\\u0026nbsp;females\\u0026nbsp;aged 20-35 years with normal menstrual history and had at least one offspring after spontaneous pregnancy.\\u0026nbsp;\\u0026nbsp;The study was done after approval from the Ethical Committee of Faculty of Medicine at Obstetrics\\u0026nbsp;and Gynecology\\u0026nbsp;department in Tanta University Hospital, Egypt between March 2021 to March 2022. All participants provided informed written\\u0026nbsp;consent.\\u003c/p\\u003e\\n\\u003cp\\u003eExclusion criteria were any disease affects uterus (uterine tumors fibroids, endometriosis, prolapse, or tuberculosis), ovarian tumors, submucous myoma, irregular menstrual cycle, past or family history of breast disease ,thyroid, DVT, migraine, diabetic patients ,medication affecting reproductive or metabolic functions and an endometrial thickness \\u0026lt;7\\u0026thinsp;mm on the secretory transformation day, a history of spontaneous abortions or embryo transfer failure on over three occasions, patients had cortisol medications,\\u0026nbsp;and\\u0026nbsp;patients who received radiological treatment.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSubjects\\u0026nbsp;were\\u0026nbsp;classified into four\\u0026nbsp;equal groups\\u0026nbsp;according to\\u0026nbsp;contraceptive method: group\\u0026nbsp;D(Depo-Provera\\u0026reg;): \\u0026nbsp;used the injectable progesterone\\u0026nbsp;of\\u0026nbsp;150 mg every 90 days or\\u0026nbsp;3\\u0026nbsp;months,\\u0026nbsp;group\\u0026nbsp;I: \\u0026nbsp;contains 68 mg of etonogestrel implant formerly known as Implanon,\\u0026nbsp;group N: used norgestrel (Ovrette\\u0026reg;), (each pill containing 0.075 mg of norgestrel)\\u0026nbsp;once daily, and\\u0026nbsp;group\\u0026nbsp;M: used IUD (Mirena)\\u0026nbsp;containing\\u0026nbsp;52 mg of levonorgestrel.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAll\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;women were subjected to\\u003c/strong\\u003e:\\u003c/p\\u003e\\n\\u003cp\\u003eDetailed\\u0026nbsp;history menstrual pattern, fertility status, any previous investigations or treatment given, with a special stress on type and method of contraception, clinical examination as heart rate and blood pressure and laboratory investigation\\u003cspan dir=\\\"RTL\\\"\\u003e.\\u003c/span\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eEndogenous progesterone measurement was performed in all groups at 21 days of cycle every month till for 6 months, ovulation (follicular size) and endometrium thickness every month for 6 months .Side effects \\u0026nbsp;as (amenorrhea and irregular bleeding) were recorded.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Efficacy and continuation rate of different contraceptive methods were recorded.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSerum sample preparation\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBlood samples were collected from cases into serum tubes which did not contain anti-coagulant and leave to clot for 30 minutes at room temperature. Centrifugation was used to separate serum, and samples were kept at -80\\u0026deg;C until analysis. After defrosting the serum samples on ice, 0.5 mL of serum was transferred to a 10 mL glass centrifuge tube. Every serum sample was spiked with 10 \\u0026mu;L of internal standard, 1 mL 100 mM potassium phosphate, pH 9-, and 4-mL pentane was added. The samples were transported into injection vials for analysis by liquid chromatography-mass spectrometry (LC/MS/MS).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eUltrasound for endometrium thickness\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe endometrium was measured by ultrasound in the long axis or sagittal plane, ideally on transvaginal scanning, with the entirety of the endometrial lining through to the endocervical canal in view. \\u0026nbsp;The thickness of the echogenic area from one endometrial base across the endometrial canal to the other endometrial base was measured.\\u003c/p\\u003e\\n\\u003ch3\\u003eSample size\\u0026nbsp;calculation\\u003c/h3\\u003e\\n\\u003cp\\u003eG. power 3.1.9.2 was used to calculate the sample size (Universitat Kiel, Germany). The sample size was based on the following: 0.05 \\u0026alpha; error and 90% power, allocation ratio 1:1 to demonstrate \\u0026nbsp;the incidence of amenorrhea with Mirena 20%\\u0026nbsp;\\u003csup\\u003e[13]\\u003c/sup\\u003e versus Depo-Provera (75%)\\u0026nbsp;\\u003csup\\u003e[14]\\u003c/sup\\u003e according to previous studies. three cases were added to overcome dropout. As a result, twenty patients were recruited in each group.\\u003c/p\\u003e\\n\\u003cp\\u003eOur outcomes were the incidence of side effects, endogenous progesterone level, and ovulation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSPSS version 26 was used for statistical analysis (IBM Inc., Chicago, IL, USA). The mean and standard deviation (SD) of quantitative variables were calculated and compared using the ANOVA test with post hoc (Tukey) test. The frequency and percentage values of qualitative variables were evaluated statistically using the Chi-square test. Statistical significance was defined as a two-tailed P value of 0.05.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eWe included 80patients, 20 patients in groupd,20 patients in group I, 20 patients in group and 20patients in group M. \\u003cstrong\\u003eFigure 1\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDemographic data,\\u0026nbsp;menstrual cycle, parity, and mode of delivery\\u0026nbsp;were comparable among the four groups. Table1\\u003c/p\\u003e\\n\\u003cp\\u003eEndogenous\\u0026nbsp;progesterone\\u0026nbsp;level was significantly higher in group M than other three groups at 1\\u003csup\\u003est\\u003c/sup\\u003e month till 6\\u003csup\\u003eth\\u003c/sup\\u003e month of measurements (P =0.001), while there was an insignificant difference among the other three groups. There was an insignificant difference among the four groups at baseline measurement.\\u0026nbsp;\\u003cstrong\\u003eTable 2\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFollicle size was significantly higher in group M than other three groups (P =0.001) and there was an insignificant difference among the other three groups. \\u003cstrong\\u003eFigure 2\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAmenorrhea was\\u0026nbsp;significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference\\u0026nbsp;among the other three groups. Irregular bleeding was insignificantly different among the four groups.\\u0026nbsp;\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eContinuation rate was noticeably higher in group M than other three groups after 6 months\\u0026nbsp;while there was an insignificant difference among other three groups.\\u0026nbsp;Unintended pregnancies were insignificantly different among the four studied groups. \\u003cstrong\\u003eTable 5\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEndometrium thickness\\u0026nbsp;was insignificantly different among the four groups at 1\\u003csup\\u003est\\u003c/sup\\u003e month till 6\\u003csup\\u003eth\\u003c/sup\\u003e month. \\u003cstrong\\u003eFigure 3\\u003c/strong\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eLARCs are increasingly prevalent among females looking for contraception\\u0026nbsp;\\u003csup\\u003e[15]\\u003c/sup\\u003e\\u003cstrong\\u003e.\\u003c/strong\\u003e Progestogens are the primary active ingredient in hormonal contraception, as they have essentially three modes of action, their structure and the action profile are different, they show a multifocal form of action in contraception. Moreover, the normal progestogenic effect, each progestogen has a partial effect pattern, and different effects on endogenous progesterone and ovulation rate with different side effects\\u0026nbsp;\\u003csup\\u003e[16]\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIn our study, Mirena had higher endogenous progesterone level compared to the other contraceptives containing progesterone (oral, Implanon and injectable progesterone), this may be due to the high systemic absorption of exogenous progesterone from other methods while Mirena had low systemic absorption of progesterone. Also, women who used Mirena had normal follicle size compared to other three groups but other three groups had low follicle size.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eBarbosa et al.\\u003csup\\u003e[17]\\u003c/sup\\u003e studied the effect of IUD on ovarian function and found that the dose of levonorgestrel delivered from the IUD is low, it probably exerts an effect on the gonadotrophin secretion, which disturbs follicular development in many of the studied women, as well as its local effect on the endometrium, contributes to its high contraceptive efficacy.\\u003c/p\\u003e\\n\\u003cp\\u003eIn current research, endometrium thickness was significantly lower in the four contraceptive methods \\u0026lt;8mm.\\u003c/p\\u003e\\n\\u003cp\\u003eIn Yang et al\\u003csup\\u003e[18]\\u003c/sup\\u003e, reported that the endometrial thickness, menstrual time in the group who had Mirena were better than those in the control group when they\\u0026nbsp;evaluated of the efficacy of Mirena combined with hysteroscopic surgery.\\u003c/p\\u003e\\n\\u003cp\\u003eAmenorrhea was\\u0026nbsp;significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference\\u0026nbsp;among the other three groups. Irregular bleeding was insignificantly different among the four groups.\\u003c/p\\u003e\\n\\u003cp\\u003eConsistent with our findings,\\u0026nbsp;Pedro et al, found that\\u0026nbsp;incidence of amenorrhea with women who had used Mirena was 13% while in women who had used Depo Provera was 75%.\\u003c/p\\u003e\\n\\u003cp\\u003eAlso, in\\u0026nbsp;Sergison et al.\\u003csup\\u003e[19]\\u003c/sup\\u003e who showed prevalence of amenorrhea with IUD and found that, 18.2% of participants underwent amenorrhea for at least \\u0026nbsp;90-day interval throughout the 1\\u003csup\\u003est\\u003c/sup\\u003e\\u0026nbsp; year.\\u003c/p\\u003e\\n\\u003cp\\u003eIn previous clinical study\\u003csup\\u003e[20]\\u003c/sup\\u003e most women who used Depo Provera have experienced menstrual irregularities with continues use ,amenorrhea becomes common, reported by 57% of the women after a year of usage.\\u003c/p\\u003e\\n\\u003cp\\u003eIn our study incidence of irregular bleeding was 80% with group D, 65% with group I 70% with N group and 45% with M group.\\u003c/p\\u003e\\n\\u003cp\\u003eIn\\u0026nbsp;Regidor et al,\\u003csup\\u003e[21]\\u003c/sup\\u003e found that\\u0026nbsp;incidence of\\u0026nbsp;irregular bleeding\\u0026nbsp;with women who had used Mirena was (50%) while in women who had used Depo Provera was (75%).\\u003c/p\\u003e\\n\\u003cp\\u003eWong et al.\\u0026nbsp;\\u003csup\\u003e[22]\\u003c/sup\\u003e found that 4.5% of the IUD users reported abnormal bleeding as their reason for discontinuation. Similarly, Teal et al.\\u003csup\\u003e[23]\\u003c/sup\\u003e\\u0026nbsp; found that 8% of the adolescent IUD users in their study reported abnormal bleeding as their reason for discontinuation. These studies and ours provide evidence that unsatisfactory bleeding with IUDs tends to be less common than unsatisfactory bleeding with Depo-Provera.\\u003c/p\\u003e\\n\\u003cp\\u003eMoreover, Howard et al.\\u0026nbsp;\\u003csup\\u003e[24]\\u003c/sup\\u003e found that only 16% of Mirena users found the\\u0026nbsp;unpredictability of their bleeding unacceptable at 6 months of follow-up, when compared between Mirena and\\u0026nbsp;Depo-Provera.\\u003c/p\\u003e\\n\\u003cp\\u003eContinuation rate was notably greater in group M than other three groups after 6 months\\u0026nbsp;while there was an insignificant difference among the four studied groups.\\u0026nbsp;Efficacy of the different contraceptive method was comparable among four studied groups.\\u003c/p\\u003e\\n\\u003cp\\u003eMoreau et al,\\u003csup\\u003e[25]\\u003c/sup\\u003e using data from the National Survey of Family Growth found that 33.7% of women who discontinued Depo-Provera reported that dislike of the changes in menstrual periods was their reason for discontinuation.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIn\\u0026nbsp;Peipert et al.,\\u003csup\\u003e[26]\\u003c/sup\\u003e who studied\\u0026nbsp;maintenance and satisfaction of reversible contraception\\u0026nbsp;and found that the highest rate of continuation was with LNG-IUS (88%).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eCompared to other reversible methods, the LNG-IUS is among the most effective with a failure rate of 0.1% in the first year \\u0026ndash; like or even better than female sterilization\\u003c/p\\u003e\\n\\u003cp\\u003eOur study had certain limitation as single center study with insufficient sample size, follow-up period is brief and absence of randomization as participants were not assigned a contraceptive technique at random, their expectations of a contraceptive method may be different from the outset. We did not believe that randomizing patients to a method of contraception was ethical, and that randomization could have a negative effect on continuance, which was one of our outcomes.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eMirena had low systemic absorption of exogenous progesterone so, it had less effect on endogenous progesterone with better follicle size and low incidence of side effects (amenorrhea) compared to other contraceptives containing progesterone. Therefore, Mirena is an effective and safe contraceptive method that can be used with women who had complication with using progesterone containing contraceptive methods.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003cp\\u003e1. Regidor P-A. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38.\\u003c/p\\u003e\\n\\u003cp\\u003e2. De Sanctis V, Soliman AT, Daar S, Canatan D, Di Maio S, Kattamis C. Current Issues and Options for Hormonal Contraception in Adolescents and Young Adult Women With Sickle Cell Disease: An Update for Health Care Professionals. Mediterranean journal of hematology and infectious diseases. 2020;12:13-1.\\u003c/p\\u003e\\n\\u003cp\\u003e3. Jacobstein R, Polis CB. Progestin-only contraception: Injectables and implants. Best Pract Res Clin Obstet Gynaecol. 2014;28:795-806.\\u003c/p\\u003e\\n\\u003cp\\u003e4. Ma Z, Zhang H, Wang Y, Tang X. Development and evaluation of intramuscularly administered nano/microcrystal suspension. Expert Opin Drug Deliv. 2019;16:347-61.\\u003c/p\\u003e\\n\\u003cp\\u003e5. Bruni V, Dei M, Pampaloni F. Hormonal contraception. Female Reproductive Dysfunction. 2020:123-52.\\u003c/p\\u003e\\n\\u003cp\\u003e6. Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. Open Access J Contracept. 2016;7:43-52.\\u003c/p\\u003e\\n\\u003cp\\u003e7. Rocca ML, Palumbo AR, Visconti F, Di Carlo C. Safety and benefits of contraceptives implants: A systematic review. Pharmaceuticals (Basel, Switzerland). 2021;14:548.\\u003c/p\\u003e\\n\\u003cp\\u003e8. Moray KV, Chaurasia H, Sachin O, Joshi B. A Systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18:1-24.\\u003c/p\\u003e\\n\\u003cp\\u003e9. Powell A. Choosing the right oral contraceptive pill for teens. Pediatr Clin North Am. 2017;64:343-58.\\u003c/p\\u003e\\n\\u003cp\\u003e10. Ingle S, Tegeli V, Javalgikar A, Matole V, Koli L, Birajdar A, et al. A Brief review on intra-uterine drug delivery systems. RJPDFT. 2021;13:72-5.\\u003c/p\\u003e\\n\\u003cp\\u003e11. Bao Q, Gu B, Price CF, Zou Y, Wang Y, Kozak D, et al. Manufacturing and characterization of long-acting levonorgestrel intrauterine systems. International journal of pharmaceutics. 2018;550:447-54.\\u003c/p\\u003e\\n\\u003cp\\u003e12. Boog K, Cooper M. Long acting reversible contraception. Obstet Gynaecol Reprod Med 2021;31:185-91.\\u003c/p\\u003e\\n\\u003cp\\u003e13. Sergison JE, Maldonado LY, Gao X, Hubacher D. Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. American journal of obstetrics and gynecology. 2019;220:440-8.e8.\\u003c/p\\u003e\\n\\u003cp\\u003e14. Regidor P-A. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38.\\u003c/p\\u003e\\n\\u003cp\\u003e15. Buckner LR, Drobnis EZ, Augustine MS, Rogers LK, Akers J, Mott PD, et al. Cervical and systemic concentrations of long acting hormonal contraceptive (LARC) progestins depend on delivery method: Implications for the study of HIV transmission. PLoS One. 2019;14:e0214152.\\u003c/p\\u003e\\n\\u003cp\\u003e16. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38.\\u003c/p\\u003e\\n\\u003cp\\u003e17. Barbosa I, Bakos O, Olsson SE, Odlind V, Johansson ED. Ovarian function during use of a levonorgestrel-releasing IUD. Contraception. 1990;42:51-66.\\u003c/p\\u003e\\n\\u003cp\\u003e18. Yang Z, Shao L, Teng Y. Evaluation of the Efficacy and Adverse Reactions of Mirena Combined with Hysteroscopic Surgery When Treating AUB: Based on a Retrospective Cohort Study. Computational and Mathematical Methods in Medicine. 2022;2022:4082266.\\u003c/p\\u003e\\n\\u003cp\\u003e19. Sergison JE, Maldonado LY, Gao X, Hubacher D. Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;220:440-8.\\u003c/p\\u003e\\n\\u003cp\\u003e20. Sadeghi-Bazargani H, Fardyazar Z. Amenorrhea: an advantage rather than a complication of Depot medroxy progesterone acetate injection contraceptive. International Journal of Pharmacology. 2006;2:352-56.\\u003c/p\\u003e\\n\\u003cp\\u003e21. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018;9:34628-38.\\u003c/p\\u003e\\n\\u003cp\\u003e22. Wong RC, Bell RJ, Thunuguntla K, McNamee K, Vollenhoven B. Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception. 2009;80:452-6.\\u003c/p\\u003e\\n\\u003cp\\u003e23. Teal SB, Sheeder J. IUD use in adolescent mothers: retention, failure and reasons for discontinuation. Contraception. 2012;85:270-4.\\u003c/p\\u003e\\n\\u003cp\\u003e24. Howard DL, Wayman R, Strickland JL. Satisfaction with and intention to continue Depo-Provera versus the Mirena IUD among post-partum adolescents through 12 months of follow-up. J Pediatr Adolesc Gynecol. 2013;26:358-65.\\u003c/p\\u003e\\n\\u003cp\\u003e25. Moreau C, Cleland K, Trussell J. Contraceptive discontinuation attributed to method dissatisfaction in the United States. Contraception. 2007;76:267-72.\\u003c/p\\u003e\\n\\u003cp\\u003e26. Peipert JF, Zhao Q, Allsworth JE, Petrosky E, Madden T, Eisenberg D, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117:1105-13.\\u003c/p\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\\\"Times New Roman\\\",serif;color:black;font-weight:bold;'\\u003eTable1: Demographic data among studied groups\\u003c/p\\u003e\\n\\u003ctable style=\\\"width: 102%;border: none;border-collapse:collapse;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 27.32%;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 0.2in;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup D (n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup I (n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup N (n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup M (n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eP value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:27.32%;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eAge/years\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e27.5 \\u0026plusmn; 5.09\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e29.35 \\u0026plusmn; 3.56\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e26.7\\u0026plusmn;5.18\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e27.9 \\u0026plusmn; 4.3\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.325\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:27.32%;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eWeight (Kg)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e67.2 \\u0026plusmn; 7.29\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e66.4 \\u0026plusmn; 7.26\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e64.8 \\u0026plusmn; 6.99\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e66.0\\u0026plusmn;7.04\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.757\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:27.32%;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eHeight (m)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e1.6 \\u0026plusmn; 0.08\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e1.6 \\u0026plusmn; 0.08\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e1.6 \\u0026plusmn; 0.08\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e1.6\\u0026plusmn; 0.09\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.233\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:27.32%;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eBMI(Kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e27.8 \\u0026plusmn; 4.42\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e25.9 \\u0026plusmn; 3.77\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e25.52 \\u0026plusmn; 2.66\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e25.9 \\u0026plusmn; 3.86\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.196\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:27.32%;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eMenstrual cycle (days)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e28.8 \\u0026plusmn; 4.18\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e29.9 \\u0026plusmn; 4.91\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e26.4 \\u0026plusmn; 4.44\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e27.9 \\u0026plusmn; 4.32\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.094\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width:12.66%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eParity\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.66%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003ePrimipara\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e4 (20%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e3 (15%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e5 (25%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e3 (15%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:10.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.824\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:14.66%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.1in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eMultipara\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.1in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e16 (80%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.1in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e17 (85%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.1in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e15 (75%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.1in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e17 (85%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width:12.66%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eMode of previous delivery\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.66%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eVaginal\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e7 (35%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e8 (40%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e11 (55%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e9 (45%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width:9.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.619\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:14.66%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eCS\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.5%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e13 (65%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:14.98%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e12 (60%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:15.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e9 (45%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:16.16%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e11 (55%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:12px;\\\"\\u003eData presented as Mean \\u0026plusmn; SD, CS: caesarian section\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;line-height:150%;'\\u003e\\u003cstrong\\u003eTable 2:\\u003c/strong\\u003e \\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eEndogenous progesterone\\u003c/span\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;level among studied groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable style=\\\"border: none;width:111.52%;border-collapse:collapse;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:34.62%;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eEndogenous progesterone (ng/ml)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.0%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup D\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.0%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup I\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e\\u0026nbsp;(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.0%;border:solid windowtext 1.0pt;border-left:none;padding: 0in 5.4pt 0in 5.4pt;height:.2in;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup N\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New 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1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e6\\u003csup\\u003eth\\u003c/sup\\u003e month\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:11.0%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e1.85\\u0026plusmn;0.88\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:11.0%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e1.95\\u0026plusmn;0.83\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:11.0%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e2.2\\u0026plusmn;0.83\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:12.12%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e11.1\\u0026plusmn;0.79\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:7.52%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.5pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.5pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP1=0.712\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.35pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP2=0.203\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.35pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP3\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.35pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP4=0.347\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.35pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP5\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 12.74%;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 2.35pt;vertical-align: bottom;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP6\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;line-height:150%;'\\u003e\\u003cspan style=\\\"font-size:12px;line-height:150%;\\\"\\u003eData presented as Mean \\u0026plusmn; SD, P value= p among four groups, P1=P value between Group D and Group I, P2=P value between Group D and N group, P3=P value between Group D and M group, P4= P value between Group I and N group, P5= P value between Group I and M group, P6= P value between N group and M group.\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;line-height:150%;'\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;line-height:150%;'\\u003e\\u003cstrong\\u003eTable 4:\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eIncidence of amenorrhea and irregular bleeding\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eamong the studied groups\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable style=\\\"width:100.0%;border-collapse:collapse;border:none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:30.78%;border:solid windowtext 1.0pt;border-bottom:solid #666666 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.18%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup D\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.38%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eGroup I\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.38%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eN group\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.24%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003eM group\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(n=20)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:8.44%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid #666666 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003ePost hoc\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:30.78%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:4.8pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eAmenorrhea\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:12.18%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.8pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e15 (75%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:12.38%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.8pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e13 (65%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:12.38%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 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style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e0.014\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.8pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP1=0.731\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP2=0.731\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP3=0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP4=1.00\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP5=0.015\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:11.6%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:2.8pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003eP6=0.015\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:30.78%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eIrregular bleeding\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.18%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e16\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e(80%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.38%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e13 (65%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.38%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e14 (70%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:12.24%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"color:black;\\\"\\u003e9 (45%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:20.04%;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:4.55pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:13px;color:black;\\\"\\u003e0.126\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:12px;\\\"\\u003eData presented as frequency (%), P value= p among four groups ,P1=P value between Group D and Group I,P2=P value between Group D and N group,P3=P value between Group D and M group, P4= P value between Group I and N group,P5= P value between Group I and M group,P6= P value between N group and M group\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;margin-bottom:12.0pt;'\\u003e\\u003cstrong\\u003eTable 5:\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eContinuation rate and unintended pregnancies\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003eamong the studied groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable style=\\\"width: 105%;margin-left:-9.25pt;border-collapse:collapse;border:none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:16.28%;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:9.9%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eGroup D\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:10.62%;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eGroup\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eI\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:10.36%;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eN group\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.32%;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eM\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003egroup\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:20.48%;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:21.06%;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:31.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003ePost hoc\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:16.28%;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eContinuation rate after 6 months\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:9.76%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e3 (15%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" rowspan=\\\"6\\\" style=\\\"width:10.74%;border-top: none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e7 (35%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:10.36%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e5 (25%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:11.32%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e15 (75%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" style=\\\"width:20.48%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP1= 0.273\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP2= 0.694\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP3= 0.000\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP4=0.730\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP5=0.026\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eP6=0.004\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width:16.28%;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003eUnintended pregnancies\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:9.76%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e2 (10%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width:10.74%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e1 (5 %)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:10.36%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e4 (20%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:11.32%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Calibri\\\",sans-serif;color:black;'\\u003e1(5%)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:20.48%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e0.343\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width:21.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:7.0pt;\\\"\\u003e\\n \\u003cp style='margin:0in;text-align:center;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:15px;color:black;\\\"\\u003e---\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"border:none;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;text-align:justify;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cspan style=\\\"font-size:12px;\\\"\\u003eData presented as frequency (%),P value= p among four groups ,P1=P value between Group D and Group I,P2=P value between Group D and N group,P3=P value between Group D and M group, P4= P value between Group I and N group,P5= P value between Group I and M group,P6= P value between N group and M group.\\u003c/span\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eSponsors and funding sources\\u003c/strong\\u003e: Nil\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of interests\\u003c/strong\\u003e: Nil\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement:\\u0026nbsp;\\u003c/strong\\u003eNil\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Endogenous Progesterone Level, Depo-Provera, Implanon, Oral, Mirena \",\"lastPublishedDoi\":\"10.21203/rs.3.rs-1644574/v2\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-1644574/v2\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e Progestogen-only’ contraceptives are presented as injections, implants, oral formulations, hormone-releasing intrauterine methods, and emergency contraceptives. The research designed to assess the effect of different progesterone containing contraceptive methods on safety and endogenous progesterone level.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eThis prospective cohort study was involved 80 healthy fertile females\\u0026nbsp;aged 20-35 years with normal menstrual history and had at least one offspring after spontaneous pregnancy. Subjects were classified into four equal groups according to contraceptive method: group D(Depo-Provera®):\\u0026nbsp;used the injectable progesterone of 150 mg every 90 days or 3 months, group I:\\u0026nbsp;contains 68 mg of etonogestrel implant formerly known as Implanon, group N: used norgestrel (Ovrette®), (each pill containing 0.075 mg of norgestrel) once daily, and group M: used IUD (Mirena) containing 52 mg of levonorgestrel.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e Group M had higher endogenous progesterone level compared to those who used other contraceptives containing with normal follicle size. Incidence of amenorrhea was significantly lower in group M (20%) than group D (75%), group I (65%), and group N (70%) with an insignificant difference among the other three groups. \\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eContinuation rate was significantly higher in group M than other three groups after 6 months. Efficacy was insignificantly different among the four groups.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eConclusion: \\u003c/strong\\u003eMirena had low systemic absorption of exogenous progesterone so, it had less effect on endogenous progesterone with better follicle size and low incidence of side effects (amenorrhea) compared to other contraceptives containing progesterone.\\u0026nbsp;\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effects of Different Progesterone Containing Contraceptive Methods on Safety and Endogenous Progesterone Level\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":2,\"date\":\"2022-08-29 02:44:05\",\"doi\":\"10.21203/rs.3.rs-1644574/v2\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}},{\"code\":1,\"date\":\"2022-05-17 17:13:56\",\"doi\":\"10.21203/rs.3.rs-1644574/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ec8c80ba-f7ad-4995-8164-b4d1e5456151\",\"owner\":[],\"postedDate\":\"August 29th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2022-05-27T15:59:11+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2022-08-29 02:44:05\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v2\",\"identity\":\"rs-1644574\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-1644574\",\"identity\":\"rs-1644574\",\"version\":[\"v2\"]},\"buildId\":\"rHA-KDH7Qsr4HCuvH75dn\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}