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A M Kaunitz

Publications and source records attributed to A M Kaunitz.

81 records · Page 5Linked to original sources
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Long-acting hormonal contraception: assessing impact on bone density, weight, and mood.

The decline in unintended pregnancies and abortions in the United States has been attributed largely to increased use of two highly effective, hormonal contraceptive methods, depot medroxyprogesterone acetate injection (DMPA) and levonorgestrel implants (Norplant). Despite the efficacy and increasing acceptability of these long-term methods, some clinicians and women are reluctant to use them because of concerns regarding reduction in bone density with DMPA, and depressive symptoms and body weight issues with both injectables and implants. Recent multicenter experience showed no increase in depressive symptoms after 1 year's DMPA use and 2 years' Norplant use, even among users with the highest mean depressive symptom scores pre-therapy. Observational studies indicate that, as with other hormonal contraceptives and hormone replacement, DMPA does not cause significant weight gain, even during long-term use. Multicenter experience with the new soft-tubing Norplant product found an average annual pregnancy rate of <1% and a cumulative 5-year pregnancy rate of 4.2% in women weighing 70 kg or more--substantially lower than failure rates cited in the product labeling. Trends in bone density seen with DMPA appear similar to those during lactation. Subgroups of long-term DMPA users may experience a decrease in spinal bone density that appears to be reversible following discontinuation. A once-a-month injectable contraceptive combining 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate (Cyclo-Provera, Cyclofem or Lunelle), a 2-rod levonorgestrel system, and a single-rod 3-ketodesogestrel implant system may become available in the United States. Large-scale trials have established the safety, efficacy, and acceptability of Cyclo-Provera. In contrast to DMPA, users of Cyclo-Provera experience predictable, regular monthly bleeding, fewer discontinue due to bleeding-related problems. Fertility returns rapidly following discontinuation. A U.S. multicenter study is currently nearing completion.

Affect↗
PubMedDate not supplied

The hormone continuum: accrual of women's health benefits.

The hormone continuum is a treatment strategy that advocates maintaining hormone continuity, from the reproductive years into menopause and beyond. This entails the use first of oral contraceptives (OCs), which confer well-known health benefits--especially reductions in ovarian and endometrial cancers--besides effective contraception, and later, hormone replacement therapy (HRT), which provides relief of perimenopausal and menopausal symptoms and protects older women from (a) decreasing bone mineral density; (b) cardiovascular disease, according to several studies; and (c) Alzheimer's disease, as suggested by a number of studies. In perimenopause, use of OCs declines by about one-half, and then by a further four-fifths up to menopause. This is unfortunate, because in these later reproductive years women are subject to unintended pregnancy, which in 65% of cases is terminated by abortion. Furthermore, women are thereby deprived also of alleviation of dysmenorrhea and even vasomotor symptoms that often characterize the perimenopause. After menopause is well established, a "seamless" transition to HRT can be made, often with the same progestin that was contained in the OC. This paper discusses risks as well as benefits of hormone therapy, especially of HRT, with an emphasis on patient counseling and individualizing of therapy.

Adult↗
PubMedDate not supplied

Long-acting contraceptive options.

Long-acting contraceptive methods are appropriate choices for women who prefer the convenience and high contraceptive efficacy of methods not requiring frequent compliance, and women for whom contraceptive doses of estrogen are either medically contraindicated or associated with persistent intolerable side effects. Annual pregnancy rates for the three methods described below are less than 1 per 100 woman-years. As currently formulated, levonorgestrel implants (Norplant) consist of six 34 x 2.4 mm soft plastic implants, each filled with 36 mg of crystalline levonorgestrel. Irregular and often persistent menstrual bleeding and spotting constitute the most important side effects experienced by and leading to method discontinuation in implant users. Implant removal is technically more difficult and time-consuming than insertion. Depot-medroxyprogesterone acetate (DMPA or Depo-Provera) is injected as an aqueous suspension of microcrystals. Intramuscular injection of 150 mg of DMPA results in more than 3 months of contraception. Irregular bleeding and spotting followed by amenorrhea, constitute the most importance side effects experienced by DMPA users. Because DMPA use can result in prolonged (but not permanent) infertility, DMPA is not an optimum contraceptive choice for women who may want to conceive in the next one or two years. The Copper T380A intrauterine device (IUD) provides reversible contraception for up to 10 years. IUDs act as contraceptives, not early abortafacients. Recent epidemiologic data indicate that long-term IUD use does not increase the occurrence of pelvic inflammatory disease. Heavier menstrual flow and cramps constitute the main side effects experienced by women using the copper IUD. Intrauterine device insertion and removal are accomplished during brief office-based procedures.

Adolescent↗
PubMedDate not supplied

Contraception for the adolescent patient.

Physicians who provide care for adolescents are well positioned to help prevent the negative consequences of sexual activity--unintended pregnancy and sexually transmitted diseases. Physicians should look for opportunities to emphasize the advantages of postponing sexual involvement. Nonetheless, we should recognize that few adolescents come to us seeking opinions about their sexual behavior. Instead, they come for information on contraception and STDs. In caring for sexually active teens, therefore, our role should be to encourage responsible sexual behavior, not to moralize about it. Countries such as Holland, a society which focuses on providing health services for sexually active teens rather than value judgments, has achieved rates of pregnancy and abortion remarkably lower than those experienced by U.S. adolescents. Although oral contraceptives (OCs) are well tolerated by most teens, achieving OC compliance and continuation represents a major challenge for many teenage patients. Often, use of the long-acting hormonal methods Depo-Provera or Norplant represents a more practical approach to achieving effective contraception for teenagers. Initial experience in the United States suggests that teens appreciate the freedom from daily compliance provided by these long-acting hormonal methods. Practical issues relative to achieving patient satisfaction and effective, safe contraception will be reviewed with respect to Depo-Provera, Norplant and OCs. Because STDs occur so frequently in teens, the "belt and suspenders" approach to contraception often makes sense: hormonal contraception plus condoms. Many would agree with the comment: "It's no longer diamonds. Now, condoms are a girl's best friend." Physicians who focus on health care rather than moral issues can still encourage responsible behavior and improve health outcomes in this important group of patients.

Adolescent↗
PubMedDate not supplied

Reappearance of the intrauterine device: a 'user-friendly' contraceptive.

Women in the United States, and their physicians, are "rediscovering" intrauterine devices (IUDs). Two IUDs, the 10-year Copper T 380A (Paragard) and 1-year progesterone-releasing T (Progestasert) are currently marketed in this country. In contrast to previous perceptions, recent studies have provided reassurance regarding the safety of these effective and convenient contraceptives. We now recognize that IUDs do not increase salpingitis or infertility risks in long-term users. Likewise, we now better understand the mechanism of action of copper IUDs: both the inert plastic device as well as the copper contribute to a spermicidal effect, preventing fertilization. Finally, we now recognize that copper IUDs reduce a user's overall risk of ectopic pregnancy. For appropriately informed and selected candidates, IUDs represent a safe, effective, convenient, and low-cost contraceptive option.

Adolescent↗
PubMedDate not supplied

Injectable depot medroxyprogesterone acetate contraception: an update for U.S. clinicians.

Injectable contraceptions appeal to women who value the efficacy, convenience, and safety provided by this reversible birth control option. Since FDA approval for contraceptive use in 1992, depot medroxyprogesterone acetate (DMPA)--already used by millions of women worldwide--has been used by several million U.S. women. Although women using this 3-month progestin-only injectable often experience irregular bleeding and spotting (initially), long-term DMPA use typically results in amenorrhea. Many users, including adolescents, choose DMPA because of its convenience--nearly 100% contraceptive effectiveness is achieved with 4 injections per year. Because DMPA does not contain estrogen, it represents an appropriate contraceptive choice for postpartum or lactating women, as well as those whose medical status precludes use of contraceptive doses of estrogen. Some examples include: women over age 35 who smoke, those with increased thromboembolism risk, women with cardiovascular or liver disease, as well as women with complex migraines. Although fertility resumes on the average 10 months following the last injection, suppression of ovulation occasionally persists for as long as 22 months. Consequently, DMPA is not an appropriate choice for women who may wish to conceive within the next two years. Since the use of DMPA lowers ovarian estradiol production, reversible loss of bone mineral density (BMD) may occur. Studies currently in progress may clarify DMPA's long-term impact, if any, on BMD. Therapeutic uses of DMPA include treatment of: dysmenorrhea, menorrhagia (including that associated with fibroid uterine tumors), endometriosis, endometrial hyperplasia, ovulatory pain, pain associated with ovarian adhesive disease, premenstrual dysphoria and perimenopausal symptoms.

Adolescent↗