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C Westhoff

Publications and source records attributed to C Westhoff.

At least 19 recordsLinked to original sources
PubMed2002

The influence of vaginal bleeding on the sexual behavior of urban, Hispanic women and men.

Irregular menstrual bleeding associated with use of hormonal contraceptives is a leading cause of contraception discontinuation. If bleeding disrupts sexual activity, this could contribute to contraceptive discontinuation. The impact of bleeding on sexual activities other than intercourse is unknown.A self-administered questionnaire in Spanish or English was used to collect information on demographics and the practice of various sexual behaviors during times of vaginal bleeding or spotting. The questionnaire was offered consecutively to 86 men and 75 women attending urban family-planning and young men's clinics. The men and women were approached individually, not as couples. Women reported a mean age of 25 years, a wide range of educational attainment, described themselves as mostly Hispanic (89%), and most chose the Spanish version of the questionnaire (67%). Men also described themselves as mostly Hispanic (80%), and reported a similar range of educational attainment, but were younger (mean age of 21, p < 0.001), and were less likely to choose the Spanish version of the questionnaire (23%, p < 0.001).Kissing, breast touching, and receiving non-genital touching did not change during bleeding or spotting. Forty-five percent of women reported usually receiving genital touching, which declined to 6% during bleeding and to 10% during spotting (p < 0.001). Similar proportions of women reported usually giving genital touching to their partner (50%) during bleeding (41%) or spotting (44%). Men also reported usually giving less genital touching to their partner, but no change in receiving genital touching during bleeding or spotting. Forty percent of women reported usually receiving oral sex, which declined to 4% during spotting or to 0% bleeding (p < 0.001). Forty-two percent of women reported usually giving oral sex, which declined to 23% during bleeding and to 35% during spotting (p = 0.06). Fifty percent of women and 68% of men reported engaging in vaginal intercourse. Among women, reported intercourse declined to 7% during bleeding and to 26% during spotting (p < 0.001). Among men, reported intercourse declined to 19% during bleeding and to 23% during spotting (p < 0.001). The presence of vaginal bleeding or spotting is associated with decreases in genital sexual behaviors among urban, Hispanic women and men. Such disruptions in sexual behavior could contribute to contraceptive discontinuation.

Adult↗
PubMed2001

Randomized trial of oral versus vaginal misoprostol at one day after mifepristone for early medical abortion.

Mifepristone was recently approved in the United States. Regimens with shorter intervals may be more acceptable. The objective of this study was to determine whether the oral route of misoprostol was as effective as the vaginal route of misoprostol 1 day after mifepristone. A prospective, open-labeled, randomized trial of healthy adult women up to 63 days pregnant and wanting a medical abortion were randomized to use either two doses of oral misoprostol 400 microg taken 2 h apart or misoprostol 800 microg vaginally. Women self-administered misoprostol 1 day after taking one-third of the standard dose of mifepristone (200 mg) orally. Women then returned to the clinic up to 5 days later for a repeat sonogram evaluation. A dose of vaginal misoprostol was administered to women with a continuing pregnancy who then returned 1 day later to Day 15. The primary outcome measures were a complete medical abortion by the first or by the second follow-up visits. Surgical intervention was indicated for continuing pregnancy at the second follow-up visit, excessive bleeding, or persistent products of conception 5 weeks later. One thousand one hundred sixty-eight women were enrolled. Of the 1144 (98%) women who complied with their random assignment, two oral doses of misoprostol (800 microg total) were 90% effective at inducing an abortion by the first follow-up visit, compared with one dose of misoprostol by vagina of 97% (chi(2) = 23.95, p = 0.001). By the second follow-up visit, the complete abortion rate was 95% for oral misoprostol and 99% for vaginal misoprostol (chi(2) = 21.76, p = 0.001). There were minimal differences in side effects. Women preferred the oral route. The trial demonstrated that although two doses of oral misoprostol were effective, the vaginal misoprostol was more effective at inducing an early medical abortion at 1 day after low-dose mifepristone, and the regimen could be extended to 63 days gestation.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

Curettage after mifepristone-induced abortion: frequency, timing, and indications.

OBJECTIVE: To characterize women who underwent curettage after medical abortion with mifepristone and vaginal misoprostol, to describe when curettage occurred and the reasons for the intervention, and to categorize the indications for curettage according to a simple classification schema. METHODS: These analyses used data from two multisite, randomized controlled trials sponsored by Abortion Rights Mobilization. In the first study, women pregnant less than 63 days received 200 mg of mifepristone and 800 microg of vaginal misoprostol to use 48 hours after taking mifepristone. In the second study, women pregnant less than 56 days were randomly assigned to insert vaginal misoprostol at 1, 2, or 3 days after mifepristone administration. Case report forms and clinical case notes of all women who underwent curettage were examined. RESULTS: Of the 4393 women enrolled in both studies, 116 (2.6%, 95% confidence interval 2.1%, 3.1%) curettages were identified. The gestational age and a history of prior elective abortion were associated with the rate of curettage. The distribution of indications for curettage included bleeding, 61 (53%); continuing pregnancy, 17 (15%); patient request, 36 (31%); and indeterminate, 2 (1.7%). The timing of curettage differed by the indication and scheduled interval between study visits. The distribution of the timing was bimodal. One subset of women, 44 (38%), underwent curettage in the first study week and another subset, 43 (37%), during weeks 3-5. CONCLUSION: Curettage after medical abortion with mifepristone and vaginal misoprostol is rare. At least one half of the curettages were performed for persistent bleeding several weeks after treatment. Both acute heavy bleeding and continuing pregnancy are extremely rare.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

Screening for bacterial vaginosis in pregnancy.

CONTEXT: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9% to 23% of pregnant women. Symptoms include vaginal discharge, pruritus, or malodor, but often women with BV are asymptomatic. OBJECTIVES: To determine whether screening and treating pregnant women for BV reduces adverse pregnancy outcomes, as part of an assessment for the U.S. Preventive Services Task Force. DATA SOURCES: Randomized clinical trials of BV treatment in pregnancy that measured pregnancy outcomes were identified from multiple searches in MEDLINE from 1966 to 1999, the Cochrane Controlled Trials Register and Library, and national experts. STUDY SELECTION: All randomized controlled trials of BV treatment in pregnancy that specifically measured pregnancy outcomes. DATA EXTRACTION: The following information was abstracted: study design and blinding, diagnostic methods, antibiotic interventions, timing of antibiotic treatment in pregnancy, criteria for treatment, comorbidities, demographic details, risk factors for preterm delivery such as previous preterm delivery, compliance, rates of spontaneous and total preterm delivery less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2500 grams, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group (the absolute risk reduction [ARR]). A stepwise procedure based on the profile likelihood was applied to assess heterogeneity, to pool studies when appropriate, and to calculate the mean and 90% confidence intervals (CIs) for the effect of treatment. DATA SYNTHESIS: Seven randomized controlled trials met inclusion criteria for the meta-analysis. We found no benefit to BV treatment in average-risk women for any pregnancy outcome. Results of studies of high-risk populations, women with previous preterm delivery, were statistically heterogeneous. They clustered into two groups; one showed no benefit (ARR=-0.08, 90% CI=-0.19 to 0.04), whereas the three homogeneous studies showed potential benefit of BV treatment (pooled ARR=0.22; 90% CI=0.13 to 0.31) for preterm delivery before 37 weeks. Four high-risk studies reported results for preterm delivery less than 34 weeks. The pooled estimate showed no benefit (ARR=0.04; 90% CI=-0.02 to 0.09), but variation was noted among individual studies. Two trials of high-risk women found an increase in preterm delivery less than 34 weeks in women who did not have BV but received BV treatment. Comparisons of patient populations, treatment regimens, and study designs did not explain the heterogeneity among studies. CONCLUSIONS: We found no benefit to routine BV screening and treatment. A subgroup of high-risk women may benefit from BV screening and treatment; however, there may be a subgroup for whom BV treatment could increase the occurrence of preterm delivery.

Female↗
PubMed2001

Criteria for appropriate birth control.

Women seeking protection from pregnancy require adequate information about the relative merits and risks of current contraceptive options in order to make an informed choice. A basic understanding of mechanisms of action, the projected rates of efficacy, the demands on compliance, and the risks of side-effects permits women to weigh options appropriately and attain confidence in their chosen method. An informed woman is also in a better position to switch to alternative methods in the event of dissatisfaction or changing needs. Within the category of highly effective methods of birth control, to which a monthly combination injectable contraceptive has recently been added in several countries, there are important distinctions in relative reversibility, effect on menstrual cycle and confidentiality.

Contraception↗
PubMed2000

Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion: A randomized trial.

CONTEXT: The conventional timing of misoprostol administration after mifepristone for medical abortion is 2 days, but more flexible intervals, which may make the regimen more convenient, have not been studied. OBJECTIVE: To determine whether vaginal misoprostol administered 1, 2, or 3 days after mifepristone influences safety or effectiveness for abortion at up to 56 days' gestation. DESIGN: Prospective, randomized, open-label trial conducted from March 1998 to June 1999. SETTING: Sixteen US primary care and referral abortion facilities. PATIENTS: A total of 2295 healthy patients aged 18 years or older who were 56 or fewer days pregnant. Forty (1.7%) were lost to follow-up. INTERVENTIONS: Patients received 200 mg of oral mifepristone and were randomly assigned to self-administer 800 microg of vaginal misoprostol at home 1 (n = 745), 2 (n = 778), or 3 (n = 772) days later. Women returned to the clinic up to 8 days after mifepristone for ultrasonographic evaluation. A second dose of misoprostol was administered if the abortion was not complete. Patients with continuing pregnancy, excessive bleeding, or retained pregnancy tissue 5 weeks later received an aspiration curettage. MAIN OUTCOME MEASURES: Effectiveness of the procedure (ie, a complete medical abortion without surgical intervention), adverse effects, acceptability of the procedure based on patient questionnaires, reasons for surgical intervention, and adverse outcomes, compared among the study groups. RESULTS: Of the 2255 women completing follow-up, complete medical abortion rates were 98% (95% confidence interval [CI], 97%-99%) among those using misoprostol after 1 day, 98% (95% CI, 97%-99%) for those using misoprostol after 2 days, and 96% (95% CI, 95%-97%) among those using misoprostol after 3 days. Fifty-five subjects aborted before taking misoprostol, 9 had early surgery, and 103 did not take misoprostol on their assigned day. No blood transfusions were required. Cramping and nausea were the most common adverse effects reported, with similar percentages of patients in all 3 groups reporting such effects. Thirteen unexpected or serious adverse events occurred: 6 in those using misoprostol after 1 day; 4 in those using it after 2 days; and 3 in those using it after 3 days. Nearly all women (>90%) found the procedure to be acceptable. CONCLUSIONS: Our results suggest that vaginal misoprostol, 800 microg, can be used from 1 to 3 days after mifepristone, 200 mg, for early medical abortion, and need not be administered strictly 48 hours after mifepristone. JAMA. 2000;284:1948-1953.

Abortifacient Agents↗
PubMed2000

Oral contraceptive and benign ovarian tumors.

Whether use of combined oral contraceptives (OC) protects against benign ovarian tumors is unknown. A case-control study of pathologically confirmed benign ovarian tumors was conducted in the New York City area and included cases diagnosed from January 1, 1992, to December 31, 1993, and controls identified by random digit dialing. There were 196 cases with serous adenomas, 176 with teratomas, 311 with endometriomas, and 65 with mucinous adenomas. Interview data were used to determine contraceptive use. Ever use of OC was associated with a decreased risk of these benign tumors (age- and hospital-adjusted odds ratio = 0.79, 95% confidence interval: 0.60, 1.05). In histologic subgroup analyses, the risk of ovarian tumors was reduced for both current and past OC users. Among tumor subtypes, the risk reduction was greatest for women who had endometriotic lesions. The risk reduction also was greater for women who had used OC for more than 24 months. Protection against benign ovarian tumors may be an additional noncontraceptive benefit of OC use.

Adenoma↗
PubMed2000

Predictors of analgesia use during supervised medical abortion. The Mifepristone Clinical Trials Group.

The object of this analysis was to identify predictors of narcotic analgesic use during medical abortion. A total of 2121 women with pregnancies of </=63 days gestational age received 600 mg mifepristone followed 48 h later by 400 microg oral misoprostol in a single arm clinical trial perfomed at 17 centers in the US. We tested the effects of subject characteristics at baseline and study centers on the use of any narcotic analgesics on the day of misoprostol use. Overall, 27% of subjects received narcotic analgesics. The main determinant of narcotic analgesic use was the study center. The relative risk of using narcotic analgesics increased with gestational age; the relative risk decreased in women with previous births, and also decreased with increasing age of the woman receiving treatment. It is concluded use of narcotic analgesia during medical abortion is least likely among older, parous women at low gestational ages; however, the clinic providing care for the patient was the most important determinant of who received narcotic analgesia.

Abortifacient Agents, Nonsteroidal↗
PubMed2000

Timing of pain and bleeding after mifepristone-induced abortion.

Previous studies of medical abortion with mifepristone and a prostaglandin have reported percentages of subjects who experience cramping and/or bleeding relative to prostaglandin use. This is the first analysis of cramping and bleeding onset patterns in subjects treated with low-dose (200 mg) mifepristone and 800 microg vaginal misoprostol at 24, 48, or 72 h after mifepristone. We analyzed the cramping and bleeding onset patterns in subjects up to 8 weeks pregnant who used 800 microg vaginal misoprostol at 24, 48, or 72 h after 200 mg of oral mifepristone. We collected data from subjects' symptom diaries and divided symptom onset into 3 categories: before misoprostol use, 0--12 h following misoprostol, and more than 12 h after misoprostol. Of the 2,302 subjects, cramping and bleeding onset data were available for 2,030 (88%) and 2,123 (92%), respectively. Across all groups, 230 (11%) experienced cramping and 445 (21%) experienced bleeding before misoprostol use. There was a significantly higher percentage of subjects who experienced early cramping and/or early bleeding between the three treatment groups, and this was related to the interval between mifepristone and misoprostol. In the 12 h following misoprostol administration, cramping and bleeding patterns were similar in the three groups. The longer subjects waited to insert misoprostol, the more likely they were to experience early cramping and/or bleeding. After misoprostol insertion, cramping and bleeding patterns are similar regardless of treatment group. Patients and providers cannot rely on symptom onset to predict treatment success.

Abortifacient Agents, Nonsteroidal↗
PubMed2000

Tubal sterilization: focus on the U.S. experience.

OBJECTIVE: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. DESIGN: A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications. PATIENT(S): Women seeking tubal sterilization. INTERVENTION: Tubal sterilization. MAIN OUTCOME MEASURE(S): Effectiveness and long-term risks and benefits. RESULT(S): Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. CONCLUSION(S): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.

Adolescent↗
PubMed2000

Predictors of ovarian follicle number.

OBJECTIVE: To identify factors associated with ovarian follicle density in women of reproductive age. DESIGN: Women undergoing incidental oophorectomy responded to structured interviews. Grossly normal ovaries were sectioned and assessed for follicle density. SETTING: University hospital. PATIENT(S): 102 women undergoing hysterectomy with incidental oophorectomy who had morphologically normal ovaries. MAIN OUTCOME MEASURE(S): Follicle density, age, parity, oral contraceptive use, body size, smoking, and alcohol consumption. RESULT(S): Follicle density decreased with age and with current or past cigarette smoking. Other factors were not associated with follicle density, although the study had adequate power to detect only strong associations. CONCLUSION(S): Some of the adverse effects of smoking on reproductive health may be due to irreversible follicular depletion.

Adult↗
PubMed2000

Diet and benign ovarian tumors (United States).

OBJECTIVES: The relation between benign ovarian tumors (BOTs) and nutrients, primarily dietary fat, was examined using case-control data. METHODS: 746 cases were diagnosed from 1 January 1992 to 31 December 1993. The 404 age- and hospital frequency-matched community controls were identified by random digit dialing. Six hundred seventy-three cases and 351 controls provided dietary information. RESULTS: The risk of BOTs was elevated for the highest vs. lowest quartile of intake of total, vegetable, saturated, monounsaturated, and polyunsaturated fat. The corresponding age-, hospital-, total energy-, and body mass index-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are 1.3 (0.9-1.9), 1.7 (1.2-2.5), 1.2 (0.8-1.8), 1.3 (0.9-1.8), and 1.6 (1.1-2.3). After adjustment for polyunsaturated fat, the risk of BOTs only remained elevated for vegetable fat (highest vs. lowest quartile OR and 95% CI = 1.4 (0.8-2.3)). Elevated risks were observed for higher intakes of polyunsaturated fat with endometrioid, serous, and teratoma tumors. Higher intakes of vegetable fat, adjusted for polyunsaturated fat, increased the risk of endometrioid, mucinous, and serous tumors. Only the risk of serous BOTs was consistently lower for higher intakes of micronutrients, with the strongest reduction observed for sources of vitamin A. Estimates were not confounded by non-nutrient covariates. CONCLUSIONS: Polyunsaturated and vegetable fat may increase the risk of BOTs, while vitamin A may lower the risk of serous BOTs; however, these findings and lack of associations for other nutrients should be replicated.

Adolescent↗
PubMed2000

Lactose and benign ovarian tumours in a case-control study.

We investigated the relation between benign ovarian tumours and lactose among 746 case women identified at seven New York metropolitan hospitals and 404 community controls, age and hospital frequency matched to the expected case distribution. No increase in risk was found for lactose (highest quartile versus lowest: adjusted odds ratio = 0.82 (95% CI 0.57-1.20) or for any other lactose foods.

Adenoma↗
PubMed2000

Risk factors for hyperplasia-associated versus atrophy-associated endometrial carcinoma.

OBJECTIVE: Endometrial cancer can be divided into atrophy-associated and hyperplasia-associated subtypes. It has been suggested that these subtypes have different pathologic features and prognoses. This preliminary study explores whether these subtypes are associated with different risk factors. STUDY DESIGN: Hysterectomies performed in cases of endometrial carcinoma with evaluable benign endometrium on routine processing were reviewed, and clinical data were abstracted from medical records. Forty-eight subjects with atrophy-associated and 28 subjects with hyperplasia-associated cancers were studied. RESULTS: We found younger age, higher weight, absence of cigarette smoking, and earlier menarche in subjects with hyperplasia-related cancers. CONCLUSIONS: Our findings support the idea that hyperplasia-associated endometrial cancer is estrogen-related but also suggest that atrophy-associated cases may result from a different causal pathway. Epidemiologic studies may yield more precise and accurate measures of association if atrophy-associated and hyperplasia-associated endometrial cancers are considered separately.

Adenocarcinoma↗
PubMed2000

Bleeding patterns after early abortion with mifepristone and misoprostol or manual vacuum aspiration.

OBJECTIVE: To prospectively determine patterns and predictors of bleeding after early abortion with mifepristone and misoprostol or manual vacuum aspiration (MVA). METHODS: Women fewer than 63 days from the last menstrual period and desiring termination of pregnancy were offered medical abortion with 200 mg oral mifepristone and 800 micrograms oral misoprostol or MVA under local anesthesia. Women completed a bleeding diary during the six weeks after abortion. Telephone calls were used to encourage diary completion and determine contraception use. RESULTS: 212 women were enrolled, 80% of whom completed diaries. Mean days of bleeding was higher in the medical (14 days) than MVA (9 days) group, but days of spotting (about 10) was similar in both groups. Increasing gestational age predicted more bleeding or spotting days after medical, but not MVA, abortion. Prolonged bleeding was not rare and was more common in the medical than the surgical abortion group. Combined oral contraceptive (COC) users and non-COC users had similar bleeding patterns after medical or surgical abortion. CONCLUSION: Bleeding after early medical abortion persists longer than after MVA and continues longer than previously appreciated regardless of method. Oral contraceptive use does not decrease bleeding after early medical or surgical abortion.

Abortion, Induced↗
PubMed2000

In-depth interviews with medical abortion clients: thoughts on the method and home administration of misoprostol.

OBJECTIVE: To document women's experiences with a home-use mifepristone-misoprostol medical abortion regimen. METHODS: We conducted in-depth interviews (n = 22) with women who received abortions in the New York City clinic of the ongoing Abortion Rights Mobilization clinical trial. Women received 200 micrograms mifepristone in the clinic and were randomized to self-administer 800 micrograms misoprostol vaginally at home either 24, 48, or 72 hours later. One week later, after their follow-up visits, women were asked to describe their experiences in their own words. RESULTS: The overwhelming majority of women found the home-use regimen acceptable. Nearly all said that they would not have preferred to return to the clinic for misoprostol, and many stated that the home-use option was the principal appeal of medical abortion. Women described the medical procedure as "natural," private, and noninvasive, and, when describing their physical experiences, noted that the side effects were more tolerable in the comfort of their homes with someone familiar nearby for support. Additionally, most women felt prepared for the experience they encountered and competent in assessing any problems that arose. CONCLUSION: Home use of misoprostol affords women more flexibility, privacy, and control in their abortions, ultimately allowing them to seek their own comfort level.

Abortifacient Agents, Nonsteroidal↗