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PubMed2001

Controlled trial with a monthly combination injectable contraceptive in Europe.

In a controlled, multicenter trial conducted in Europe, the safety and efficacy of a monthly injectable combination hormone contraceptive were found to be comparable to those of an oral contraceptive. There were no contraceptive failures in either arm of the trial. The incidence and types of side-effects were similar. The rates of patient satisfaction in the monthly injectable and oral contraceptive arms of the study were also comparable; both exceeded 90%. The results from the European study are consistent with clinical trials conducted elsewhere and support the conclusion that the monthly combination injectable contraceptive represents a desirable new birth control method. Data from the 24-week interim analyses are presented.

Adolescent↗
PubMed1993

Contraceptive practice and attitudes in former Soviet women.

For decades, abortion has been the principal birth control method for Soviet women. As indicated by some earlier local surveys, most couples use unreliable methods. Little is known about the latest trends in contraceptive use affected by the recent general liberalization of Soviet society, including more open attitudes about sex. A survey was conducted in 1991 via a questionnaire in the popular 'Health' magazine with national circulation. A total of 8059 women returned the questionnaire. The sample is selective with an overrepresentation of young and better educated urban residents, mostly from Russia and the Ukraine. Some 81% reported use of a contraceptive method during the last 5 years. Traditional methods still prevail (41% used withdrawal, rhythm and douche). Among women younger than 25 years there is a clear trend toward use of modern methods (IUD 35% and the pill 10%), although their notion of the 'pros" and 'cons' is biased. Of the respondents, 20% used a barrier method, mainly condom. The preferred method is the IUD (51%) and the pill (18%). Abortions resulting from contraceptive failure were reported by 60% of women. Eighty-nine percent considered pregnancy termination more dangerous than its prevention. For only 12% of respondents, a physician was the main source of contraceptive information, although 49% addressed him for advice. The results indicate a gap between conservative birth control practice and preferences of Russian women, with a positive general trend in the near future.

Abortion, Induced↗
PubMed2006

The intrauterine device in modern contraception: Still an actuality?

The intrauterine devices (IUD) is a contraceptive method largely used as an effective, safe and economic method of contraception; IUD efficacy is demonstrated to be about 97%, and copper IUD contraceptive failure frequency is about 0.8% for the first year of use, and this is about 0.1-0.2% for the progestin IUD. IUD benefits are different; it produces a well-defined contraceptive efficacy for long time, is useful for sexual activity and is rather free from common problems. However, IUD utilization is associated with an increasing risk of pelvic infection (0.5%) in the 8 years from initial use, and the common risk of pelvic inflammatory infection (PID) is about one to two cases per year; this risk, for copper IUD users, is 0.2-0.5% per year. The possible side effects of IUD use are: pelvic pain, irregular meshes, infections, bleeding and uterine perforation; we report a uterine perforation due to IUD migration in the Retzius space, diagnosed on transvaginal ultrasonography, confirmed on CT and removed by laparoscopy. In any case, the IUD remains the mainstay of family planning measures in developing countries but, unfortunately, its association with possible serious complications, change the cost-benefit link and restrict its utilization by a large part of the general population.

Adult↗
PubMed1992

A longitudinal evaluation of computer-assisted instruction on contraception for college students.

This study assessed changes in contraceptive knowledge of 58 white female undergraduate college students following use of a computer-assisted instruction (CAI) program on contraceptive methods. The CAI program consisted of a personal-computer-based instructional lesson covering facts about and appropriate use of oral contraceptives and barrier methods, and myths about sexuality and sexually transmitted diseases. Baseline contraceptive knowledge was first compared with 171 white female undergraduate students. This comparison indicated that, overall, there were knowledge deficits regarding the safety of oral contraceptives and what to do if oral contraceptives are not used correctly. At immediate posttest, significant knowledge gains were observed for danger signs associated with using oral contraceptives, the rationale for triphasic and biphasic pills, potential medication synergism, health benefits of using oral contraceptives, potential contraceptive effect of withdrawal, and the reasons women stop using the pill. At six-month follow-up, students evidenced long-term knowledge gains on duration of pill use, the rationale for triphasics and biphasics, appropriate contingencies for missing two days of the pill, danger signs associated with using contraceptives, medication synergism, and health benefits of using oral contraceptives. The results of the evaluation are considered in the context of the widely held assumption that young women's contraceptive failure is unrelated to knowledge deficits about methods of birth control.

Adolescent↗
PubMed1989

Contraceptive method change among rural Sri Lankan women.

Patterns of contraceptive method change and their association with reproductive motivation and contraceptive failure are examined using data from a 1986 survey of family planning behaviour of rural Sinhalese married women aged 15-44 in seventeen districts of Sri Lanka. A notable degree of rationality in contraceptive method changes occurs with family formation. The attempt to control unwanted fertility leads to more efficacious use of contraception, including traditional methods. Some methodological improvements to the analysis of contraceptive switching are indicated. Implications of the findings for programmatic emphasis on permanent versus non-permanent modern methods are discussed.

Adolescent↗
PubMed1994

Long-term benefits and risks of alternative methods of fertility control in the United States.

A risk-benefit analysis of five alternative approaches to fertility control among US women over the age of 30 was performed: tubal ligation, vasectomy, intrauterine device, barrier method (condom), and combined oral contraceptives. Taken into account were age-specific probabilities of contraceptive failure, fecundability, spontaneous abortion, reproductive mortality (ectopic pregnancy, delivery, or induced abortion), life table mortality, and mortality from specific cancer sites (ovarian, endometrial, breast, and prostate) and cardiovascular disease. Relative to women using no contraceptive precautions, the use of any method of contraception between the ages of 30 and 50 was associated with net benefit in terms of averted deaths. However, when duration of observation was extended up to age 80, we predicted an excess of about 880 deaths from prostate cancer per 100,000 users of vasectomy. Other methods continued to be associated with net benefit, ranging from 130 to 360 deaths averted per 100,000 users. It was concluded that the non-reproductive risks and benefits of contraceptive methods continue to be relevant long after the reproductive years. The balance of risks and benefits may differ in other countries with different cause-specific and life table mortality rates.

Adult↗
PubMed2006

The impact of antiepileptic drug therapy on steroidal contraceptive efficacy.

Women with epilepsy face unique challenges in maintaining steroidal contraceptive efficacy because some antiepileptic drugs (AEDs) increase the rate of hepatic metabolism of contraceptive steroids, leading to higher potential for contraceptive failure in this population. Planned pregnancy is of great clinical and social importance for women with epilepsy because of the increased risk of birth defects from fetal exposure to AEDs. Current clinical guidelines for contraceptive management in women with epilepsy provide misleading information by focusing on the estrogen content of the formulation, which regulates the menstrual cycle, rather than on the progestin content of the formulation, which provides contraceptive efficacy. This article reviews studies of AED-contraceptive interaction and misconceptions about maintaining contraceptive efficacy and makes recommendations for contraceptive management in women with epilepsy who receive concomitant AED therapy.

Anticonvulsants↗
PubMed1977

Alternatives to female sterilization.

With national policies aimed at reaching zero population growth in the shortest possible time, many countries have introduced restrictive legislation and disincentive programs in an attempt to decrease family size norms to 2 or 3 children. As a result, younger women of lower parity are being sterilized, with consequences that will be seen in the years to come. Although female sterilization is usually associated with minimal complications and side effects and is highly effective without continuing motivation or promotion, it has the disadvantage of causing permanent, essentially irreversible sterility. Therefore, it will not be readily acceptable to a large portion of the population. For many women, alternatives must be sought. Reversible methods of female or male sterilization, longacting systemic contraceptives, longacting implants, and immunization against implantation or sperm antigens are potential alternatives, but all are still in experimental stages of development. Intrauterine devices and injectables are the 2 most effective alternatives now available. The use of intrauterine devices with abortion as a backup in case of contraceptive failure ranks high as an alternative to female sterilization.

Animals↗
PubMed1986

Induced abortion. Decision and need for medical information.

This study gives attention to the preabortion encounter: to what extent medical information was provided and to what extent professional health workers took part in the decision-making process concerning abortion. During the first half year of 1983, 405 women demanding abortion at the Gynecological Department, University Hospital of Trondheim, Norway were interviewed. Ninety-five per cent of the women had a preabortion visit at a physician's office. Nearly 44% of the women were informed about the surgical procedure, while only 26% of the women were informed about the possible medical risks. Upon arrival at the hospital to have the abortion carried out 53% of the women wanted information about the surgical procedures, while 72% wanted information about possible medical complications related to the intervention. Fifty-six per cent of the women decided on abortion themselves. Seventy-six per cent (304/405) of the women had discussed termination of the pregnancy with their partners. Of these women 54% (164/304) decided on abortion together with their partners. Married women and cohabitants decided more often together with their partners than women living alone did (p less than 0.01). Only seven per cent of the women who had a preabortion visit discussed the abortion decision with their physician, while less than one per cent of the women decided on abortion during consultation with their physician. At the time of conception over 70% of the women were not using any contraceptives. Among those women who became pregnant as a result of contraceptive failure, significantly more women were either married or cohabitants.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1998

Concurrent prescribing. Beware of drug interactions.

BACKGROUND: Antibiotics are commonly prescribed to patients who are also taking other medications. Pharmacology textbooks contain long lists of potential interactions between antibiotics and other drugs, but only a few of these interactions have serious clinical consequences. OBJECTIVE: This review will highlight antibiotic interactions that are clinically significant, and the relative incidence and importance of each interaction will be considered. It will concentrate primarily on drugs commonly prescribed in general practice, such as the oral contraceptive pill and warfarin. DISCUSSION: Quinolones and macrolides are the groups of antibiotics most commonly associated with clinically significant drug interactions. Warfarin interacts with many antibiotics, although the incidence of this interaction can range from predictable to rare. The association between most antibiotics and oral contraceptive failure is weak, with only sporadic case reports in the literature.

Administration, Oral↗
PubMed1979

Contraceptive practice before and after therapeutic abortion. II. Use-effectiveness of oral contraceptives and intrauterine devices.

Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.

Abortion, Therapeutic↗
PubMedDate not supplied

St. John's wort and oral contraceptives: reasons for concern?

St. John's wort (Hypericum perforatum) is one of the best-selling herbal remedies in the United States. It has been implicated as an inducer of the P450 enzyme system, and as such, may cause increased metabolism of certain drugs, including oral contraceptives. Women using oral contraceptives have been warned against using St. John's wort. To date, there are some case reports but little clinical data demonstrating risk of contraceptive failure if they do. This article reviews available data and discusses theoretical reasons for concern about possible drug-herb interactions.

Contraceptives, Oral↗
PubMed2002

Oral contraceptive efficacy and antibiotic interaction: a myth debunked.

The purpose of this study was to review the pharmacokinetic and clinical literature regarding the efficacy of oral contraceptives when used concomitantly with antibiotic therapy. Relevant literature was identified by searching MEDLINE and EMBASE. Other sources were located by consulting the bibliographies of the material collected from MEDLINE and EMBASE. Pharmacokinetic evidence demonstrates that plasma levels of oral contraceptive steroids are unchanged with the concomitant administration of antibiotics, including ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline. However, reduced steroid levels have been reported in women taking rifampin with oral contraceptives. Clinical reports of contraceptive failure with antibiotic use are retrospective, have multiple potential biases, and are not supported by pharmacokinetic data. Available scientific and pharmacokinetic data do not support the hypothesis that antibiotics (with the exception of rifampin) lower the contraceptive efficacy of oral contraceptives.

Anti-Infective Agents↗
PubMed1994

Loss of oral contraceptive efficacy by concurrent antibiotic administration.

There are approximately 10 million women in the United States who are currently taking oral contraceptives on a daily basis. Although the actual number is not known, it is also estimated that a large number of these same women are on concomitant drug therapy. In recent years there have been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics. Whereas the actual risk of drug interaction between antibiotics and oral contraceptives is yet unknown, it is important that women who are on oral contraceptive therapy be aware of possible contraceptive failure. This article reviews the published incidence of oral contraceptive/antibiotic interaction, along with a discussion of the possible mechanisms by which this interaction occurs. Recommendations are also presented for the health management of women taking oral contraceptives and other prescribed drugs.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Emergency contraception: a simple, safe, effective and economical method for preventing undesired pregnancy].

In the following article, the most recent knowledge on emergency contraception (EC) is reviewed. EC is defined as those contraceptive methods that may be used to prevent an unwanted pregnancy up to 3 days after unprotected intercourse, contraceptive failure or rape. In case of non-hormonal methods (IUD), the time window for pregnancy prevention goes up to 5 days after intercourse. The different regimens now available, hormonal and non-hormonal methods, indications, contraceptive effectiveness, side effects and safety profile, possible mechanisms of action and counseling strategies will be reviewed. The potential benefits on reproductive health of wide-spread knowledge and easy, non-restrictive access to this methodology are emphasized. An extensive list of recent references is enclosed.

Adolescent↗
PubMedDate not supplied

[The role of induced abortion in changing fertility in Latin America].

The data and estimates presented suggest that the incidence of induced abortion in Latin America is high. In individual countries the average total abortion rate, ie lifetime induced abortions, seems to be between one and two per woman of fertile age, if not higher. The incidence of induced abortion in Latin America appears to be among the highest in the world, comparable to several East Asian and East European countries. Apparently the practice of induced abortion was already quite extensive in urban Latin America in the 1960s at a time when the use of contraception was low. As of the 1980s, induced abortion accounts for about one quarter of deliberate fertility control, and contraception for the remaining three quarters. The high incidence of induced abortion is due to an imbalance between the strong motivation for smaller families and the imperfect availability and utilization of contraception. The motivation for smaller families is widespread and contraceptive prevalence has been increasing steadily since the 1960s, yet many barriers exist to its universal and effective application. Contraceptives are not always available when needed; frequently access is difficult, particularly for young, single, and poor women and men; knowledge about reproductive functions and contraceptives is deficient and erroneous among large proportions of women; and at times the use of contraception is at odds with deeply in grained cultural and social patterns, as well as with personal sentiments. For these and other reasons, contraceptive failure is not uncommon. Consequently, the incidence of unwanted pregnancy is high and many women/couples resort to induced abortion.

Abortion, Induced↗
PubMed1993

Considerations for contraception in women with cardiovascular disorders.

Women with hypertension, angina pectoris, or mitral valve prolapse require special considerations when selecting an appropriate method of contraception. All three effective, reversible options (oral contraceptives, intrauterine devices, or progestin implants) carry some degree of added risk for these patient populations. However, pregnancy itself presents certain risks and, in the event of contraceptive failure, certain women with these disorders are at increased risk of developing serious cardiovascular sequelae that affect both mother and fetus. These negative effects can carry far into the neonatal period. This article describes the risk/benefit profiles of the currently available contraceptive options relative to their potential impact in these compromised women.

Cardiovascular Diseases↗
PubMed1994

Labeling emergency contraception.

According to the signers of a November 28 citizens' petition filed with the Food and Drug Administration (FDA), unintended pregnancies and abortions could be reduced significantly if the FDA would require the relabeling of several oral contraceptives as emergency or postcoital contraception, also known as "morning after pills." It has long been established that within 72 hours after unprotected intercourse or contraceptive failure, a specified combination of pills taken at specified intervals can reduce the risk of pregnancy by an estimated 75%. Although physicians at university health clinics, in hospital emergency rooms treating rape victims, and at some family planning clinics prescribe emergency contraceptives, other physicians are reluctant to do so without relabeling, and most women taking the pill do not know the correct dosage. Calling this a "critical public health issue," attorneys at the Center for Reproductive Law and Policy petitioned the FDA for a labeling change on the grounds that manufacturers are in fact "misbranding" pills by suppressing emergency contraceptive information. If pill makers rewrite their patient packet inserts, women undoubtedly would have far greater control over the occurrence of an unintended pregnancy, the attorneys said.

Americas↗