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PubMedDate not supplied

Barriers to effective contraception and strategies for overcoming them among adolescent mothers.

Young women often have difficulty accessing and correctly using contraception. However, these difficulties are not primarily the result of lack of knowledge or experience of contraception. In this study, nine adolescent mothers were interviewed about their experience of contraception before and after the birth of their children. These adolescent women faced barriers to effective contraceptive use before the birth of their children. These barriers included indifference to the possibility of pregnancy, perceived invulnerability to pregnancy, and forgetting to use contraception regularly. Analysis also revealed that during the time these women were sexually active prior to pregnancy, many had used a range of strategies to overcome these barriers to effective contraception, including using adult support, allowing an adult to take responsibility for contraception, and using multiple methods of contraception to cover for contraceptive failure. The strategies used by these women to delay childbearing indicate valuable areas for further research in preventing unplanned adolescent pregnancy.

Adolescent↗
PubMed2002

Ectopic IUD complicating pregnancy. A case report.

BACKGROUND: For the most part, intrauterine devices (IUDs) have a low complication rate and minimal side effects. However, one of the most common reasons for contraceptive failure while using an IUD is its translocation or extrauterine migration. Pregnancy complicated by translocation or an ectopic IUD can present a formidable clinical challenge. CASE: A 23-year-old woman, gravida 3, para 2, using a copper-7 IUD for contraception, presented at 7 weeks' gestation. Transvaginal sonogram confirmed the presence of a fetal pole with cardiac activity; however, the IUD was not detectable. An anteroposterior roentgenogram showed 90 degrees counterclockwise rotation of the IUD relative to the normal position. Laparoscopy was performed at 14 weeks. The IUD was extrauterine, buried in omental adhesions attached to the anterior abdominal wall. The IUD was dissected free and removed without difficulty. The remainder of the pregnancy was uncomplicated. CONCLUSION: Uterine perforation is a recognized and potentially hazardous complication of IUD use. Localization of a lost IUD should follow an organized and systematic approach utilizing an assortment of radiologic and operative techniques. We report the third known case utilizing laparoscopy to remove an ectopic IUD complicating early pregnancy. Laparoscopy, even during pregnancy, has proven to be a safe and simple tool for managing a variety of surgical conditions.

Adult↗
PubMed1991

Counseling patients on proper use of condoms.

The best condoms are made of latex, are lubricated and coated with a spermicide, and have a reservoir tip. Condoms can protect against conception and sexually transmitted diseases, including acquired immunodeficiency syndrome. When condoms are used properly and in combination with vaginal spermicidal foam, the contraceptive failure rate is as low as 1 percent. Failure is more often due to user error than product defect. Recommendations for the proper use of condoms are presented.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Effect of zonisamide on the pharmacokinetics and pharmacodynamics of a combination ethinyl estradiol-norethindrone oral contraceptive in healthy women.

BACKGROUND: Several antiepileptic drugs have clinically significant pharmacokinetic interactions with oral contraceptives (OCs) that may result in contraceptive failure. OBJECTIVE: The aim of this study was to assess the effect of zonisamide on the pharmacokinetics of the individual components of a combination OC (ethinyl estradiol [EE] 0.035 mg and norethindrone [NOR] 1 mg) and on pharmacodynamic variables that may be increased in the event of reduced contraceptive efficacy (concentrations of serum luteinizing hormone [LH], follicle-stimulating hormone [FSH], and progesterone). METHODS: This was a single-center, open-label, 1-sequence, crossover study. Healthy, premenopausal women received the combination OC for three 28-day cycles (combination OC for 21 days, followed by placebo for 7 days). Following stabilization on the OC during the first cycle, blood was collected during cycle 2 for the determination of serum EE and NOR profiles (day 14) and serum LH, FSH, and progesterone concentrations (days 13-15). Starting on day 15 of cycle 2, zonisamide was administered orally at 100 mg/d and titrated to a target dose of 400 mg/d. EE and NOR profiles and serum LH, FSH, and progesterone concentrations were obtained again in cycle 3 (in the presence of zonisamide) and compared with those from cycle 2 (in the absence of zonisamide). RESULTS: Thirty-seven healthy premenopausal women (mean age, 26.1 years [range, 18-51 years]; mean body weight, 65.5 kg [range, 50.4-93.1 kg]; mean height, 165.8 cm [range, 152.4-182.9 cm]) received > or =1 dose of zonisamide. Of the 33 subjects (89.2%) who completed the study, 26 (78.8%) underwent titration to a stable zonisamide dose of 400 mg/d. For EE, the mean (SD) AUC over a 24-hour dosing interval (AUC(tau)) was 1139 (317) pg.h/mL in cycle 2 and 1143 (312) pg.h/mL in cycle 3; the mean C(max) in the respective cycles was 133 (39) and 141 (46) pg/mL. For NOR, the corresponding values were 140 (48) and 159 (46) ng.h/mL for AUC(tau) and 21 (5.4) and 23 (6.7) ng/mL for C(max). The 90% Cls for the geometric mean ratios (cycle 3:cycle 2) for AUC(tau) and C(max) fell within the accepted range for lack of interaction (0.80-1.25). There were no increases in LH, FSH, or progesterone concentrations between cycle 2 and cycle 3. CONCLUSIONS: In these healthy volunteers, steady-state zonisamide dosing had no clinically significant effect on the pharmacokinetics of EE or NOR. There was no pharmacodynamic evidence that zonisamide is likely to reduce the contraceptive effectiveness of OCs containing EE and NOR.

Adult↗
PubMed1994

The incidence of repeat induced abortion--a prospective cohort study.

BACKGROUND: To measure the cumulative incidence of first and second repeat induced abortion and what differentiates first-time repeaters from non-repeaters. METHODS: The study population comprised 2,925 women who had their first induced abortion at the University Hospital of Trondheim, Norway between January 1, 1987 and December 31, 1991. Repeat induced abortion within the study period was measured as a cumulative incidence of second and third induced abortion. Survival analyses and logistic regression analysis were applied using 'repeater' as the dependent variable. RESULTS: The cumulative incidence of second induced abortion was 3.7% at end of first year, 7.1% at end of second year, 9.9% at the end of third year, and 12.3% at four completed years of observation. The cumulative incidence of third induced abortion was 0.1% at the end of first year, 0.6% at the end of second, 1.3% at the end of third and 2.0% at four years of observation. The cumulative incidence of the third abortion, measured as the time at risk from the second to the third abortion, remained twice that of the cumulative incidence of the second abortion after one year of observation (p < 0.001). At the first abortion, variables predicting a risk for repeat induced abortion were age, occupational status and becoming pregnant as a result of a contraceptive failure. CONCLUSION: Repeat induced abortion in inevitable. The incidence of repeat induced abortions doubled from the second to the third abortion, indicating that the moral threshold for choosing an abortion after recognition of an unplanned pregnancy is the first induced abortion. More detailed studies on the effect of intensified contraceptive counselling programs after the first abortion are needed.

Abortion Applicants↗
PubMed2006

Risk of pregnancy among women seeking emergency contraceptives from pharmacists in British Columbia.

OBJECTIVE: Recent revision of the method used to estimate risk of pregnancy among women requesting medication for emergency contraception (EC) suggests that the effectiveness of EC may be lower than is generally believed. We undertook a population-based study to estimate the risk of pregnancy among women requesting EC from pharmacists in British Columbia under conditions of routine care. METHODS: We obtained data on time since unprotected intercourse and medication provided for women in British Columbia requesting EC from January 1, 2001 to December 31, 2002. RESULTS: More women obtained levonorgestrel (60.7%) than the Yuzpe regimen (39.3%) for EC, and of those reporting contraceptive failure, 90% requested EC because of condom failure. Overall, the estimated risk of pregnancy among the 11 795 women who obtained EC was 4.12 % (95% confidence interval 3.77-4.49). CONCLUSION: Under routine conditions, the population-based predicted risk of pregnancy is lower than has previously been estimated. This suggests that the relative reduction in pregnancies achieved with EC is lower than is currently assumed by clinicians and patients.

Adult↗
PubMed1985

Absence of chorionic gonadotropin in sera of women who use intrauterine devices.

A controlled study was undertaken to determine whether unnoticed pregnancies routinely occur in users of the intrauterine contraceptive device (IUD). Starting on day 10 of the menstrual cycle and continuing through the onset of menstruation or until the diagnosis of pregnancy, we collected daily blood samples from three groups of normally menstruating young women. The study groups were (A) IUD users (n = 30), (B) women with tubal ligation (n = 30), and (C) women trying to become pregnant (n = 15). The sequential serum samples were analyzed by radioimmunoassay for progesterone (P), human luteinizing hormone (hLH), and human chorionic gonadotropin (hCG). No positive hCG assays in luteal phase blood sera of IUD users were observed. The only positive hCG determinations of IUD users coincided with the preovulatory surge of hLH. Two subjects who became pregnant, as judged by progressive increases in hCG and P levels in the luteal phase, belonged to the group planning pregnancy. The finding of two pregnancies in 15 months of exposure is consistent with the assumption of natural fertility. The probability of no pregnancies in 30 months at risk, as observed among the IUD users, is between 1 in 200 and 1 in 100,000, depending on the assumption made for natural fertility. The study demonstrates that IUD users do not retain their natural fertility, and that IUDs do not exert their antifertility effect as abortifacient agents. If a confirmed pregnancy is detected in an IUD user, it may be assumed to represent an isolated case of contraceptive failure.

Adult↗
PubMed2003

Unmet need and unintended fertility: longitudinal evidence from upper Egypt.

CONTEXT: Although unmet need for family planning is a standard measure for evaluating programs' effectiveness in meeting the reproductive needs of individuals, its validity and accuracy in identifying women most at risk of unintended pregnancy have been questioned. METHODS: Women who participated in the 1995 Egypt Demographic and Health Survey in two governorates in Upper Egypt (Assuit and Souhag) were followed for two years (N=2,444); in-depth data on their fertility preferences, contraceptive use and births were gathered in 1996 and 1997. Transitions among contraceptive need categories from 1995 to 1997 are examined, and rates of unintended (mistimed and unwanted) births are calculated according to contraceptive need status at baseline. RESULTS: In the aggregate, unmet need increased by six percentage points, from 28% to 34%. This change was the net outcome of 14% moving out of unmet need and 20% moving into unmet need (i.e., substantial satisfaction of unmet need was offset by increased demand for contraception). The rate of unintended fertility was far higher among women with unmet need at baseline than among contraceptive users in 1995. Women with unmet need made up about one-quarter of the baseline sample, but they contributed almost one-half of mistimed and unwanted births during the two years. The majority of unintended births were to women who had never practiced contraception, whereas fewer than one-fifth were to women with recent contraceptive experience (including contraceptive failure). CONCLUSIONS: : Unmet need for family planning remains a useful tool for identifying and targeting women at high risk of unintended pregnancy.

Contraceptive Agents↗
PubMed2005

Mirena at caesarean section.

The aim of the study was to audit the clinical experience of insertion of the Mirena intrauterine system at the time of a caesarean section. The Mirena apparatus was inserted into the fundus of the uterus after delivery of the foetus and placenta. Thirty-three patients were analysed in private practice over 32 woman-years. The audit revealed the device was extremely well tolerated. There were no contraceptive failures, no complications and no expulsions of the intrauterine device. Patient satisfaction was extremely high. At the conclusion of the audit, only one device had been removed; this descriptive study showed that the Mirena intrauterine device can be inserted into the uterus at caesarean section to provide an immediate, reliable and reversible contraceptive.

Adult↗
PubMed2001

Successful use of oral contraceptives.

Typical failure rates for oral contraceptives remain much higher than ideal failure rates. Patients can cite the pill's perceived risks more readily than its benefits, and many women use oral contraceptives inconsistently or discontinue them entirely without a medical reason. Successful use of oral contraceptives mandates that we rethink our roles as providers. Medical barriers, such as mandatory pelvic examinations, impede clients' access to services and require reevaluation. Efforts must also focus on thorough, individualized counseling. Because compliance poses difficulties for many women and noncompliance results in reduced efficacy, counseling must address content points relevant to proper, consistent use. Additionally, as unexpected side effects often cause frustration and method discontinuation, counseling should anticipate their occurrence. Adolescents present additional challenges. However, with careful attention to concerns relevant to teenage women and consideration of obstacles to compliance, oral contraceptives can indeed be used successfully in this group. Regardless of age, all clients should receive information regarding emergency contraception, and instructions for pill use should be individualized to meet the needs of each patient.

Adolescent↗
PubMed1999

Women's experiences of obtaining emergency contraception: a phenomenological study.

Emergency contraception (EC) has been available since 1984 but has been labelled the 'best kept secret' (Winfield, 1995). Because EC was originally termed 'the morning after pill', many people interpreted this literally and missed an opportunity to use the method. More recent publicity has dropped this term and emphasized that the method is effective up to 72 h after unprotected intercourse or contraceptive failure (Burton & Salvage, 1990). Uptake of EC has steadily increased since 1985 but there is still evidence that younger women in particular are least aware of its existence.

Adolescent↗
PubMed1974

King's termination study. II. Contraceptive practice before and after outpatient termination of pregnancy.

A selection of psychological and social factors present in 360 women who underwent legal termination of pregnancy are related to their contraceptive practice. One-third of the group were ignorant about contraceptive methods, ignorance being more common in women from social classes IV and V and in those under the age of 19. Nearly half of those who had some knowledge of contraceptive practice became pregnant after knowingly taking a risk. A total of 41% had been using some form of contraception immediately before conception. The reliability of contraceptive methods used was found to be inversely related to neuroticism scores obtained from the Eysenck Personality Inventory, neuroticism being highest in women who had not used any form of contraception.Of 91% of the group seen three months after their termination 86% were using reliable contraceptive methods. A follow-up study one or two years after termination has shown that 81% of the 215 women contacted so far are using a reliable method of contraception; two unwanted pregnancies have occurred but both were due to contraceptive failure. This satisfactory outcome has been ascribed to the system of counselling all women before and after termination.

Abortion, Legal↗
PubMed1990

Characteristics of women having abortion in China.

A pre-coded, closed response questionnaire was administered to women at abortion clinic sites in August 1985. The convenience sample was comprised of 1200 women, 200 samples in both Chengdu and the Lianshan Yi Autonomous Region in Sichuan Province, 400 in Nanjing and Jiangsu Province, and 400 in the municipality of Shanghai. The women were interviewed by physicians as part of the women's intake medical history. The sample yielded 574 respondents who were urban and 624 who were rural. The number of previous abortions reported ranged from 0 to 5. Nearly half of the abortion recipients had had at least one prior abortion and 18% had had two or more prior abortions. Education, age, marriage duration and residence have apparent effect on abortion order. The urban respondents reported an average of 1.08 children vs 1.60 children for the rural respondents. Approximately 72% of the respondents claimed to have been using a contraceptive method at the time they became pregnant. The most commonly used method was the IUD (41.6%), followed by the pill (21.3%) and the condom only (16.5%). Residence appeared to be the greatest factor determining the type of contraceptive methods. The data presented here are limited and cannot be generalized to the larger population. However, they do shed some light on the contraception characteristics of a group of women who undergo abortion procedures in China. Their response to questions to contracepting behavior prior to abortion suggests that the problem, in part, is behavioral. For example after the expulsion of the IUD, no other method was substituted to avert pregnancy. In order to alleviate the problem of contraceptive failure, and subsequent abortion, there are policy as well as training and education implications for the state.

Abortion Applicants↗
PubMed2002

A randomised study comparing a low dose of mifepristone and the Yuzpe regimen for emergency contraception.

OBJECTIVE: To compare 100 mg mifepristone with the standard Yuzpe regimen for emergency contraception. DESIGN: Randomised controlled trial. SETTING: Family Planning Clinic, Aberdeen. SAMPLE: One thousand women seeking emergency contraception within 72 hours after an episode of unprotected sexual intercourse. METHODS: Women were randomised to receive either 100 mg (half tablet) of mifepristone as a single dose or the Yuzpe regimen (two tablets each with 50 microg ethinyloestradiol and 0.25 mg levonorgestrel, to be repeated 12 hours later). OUTCOME MEASURES: Crude pregnancy rates, proportion of pregnancies prevented, side effects and patient acceptability. RESULTS: The crude pregnancy rates (95% CI) for the Yuzpe regimen and mifepristone were 3.6% (2.3-5.7) and 0.6% (0.2-1.8), respectively, with a significant difference between the two groups (RR 6.04; 95% CI 1.75-20.75). Mifepristone prevented 92% of pregnancies and the Yuzpe regimen preventing 56%. An increasing coitus to treatment interval was associated with contraceptive failure in the Yuzpe group (P = 0.03) with no association seen with mifepristone. Following administration of mifepristone 24.5% and 13.1% given the Yuzpe regimen had a delayed period (RR 2.14; 95% CI 1.46-3.15). Overall, mifepristone was better tolerated than the Yuzpe regimen with significantly fewer side effects. More women were satisfied (P < 0.0001) with mifepristone as an emergency contraceptive and would recommend it to a friend (P = 0.02). CONCLUSION: Mifepristone administered in a 100 mg dose is a highly effective post-coital contraceptive with high patient acceptability and fewer side effects compared with the standard Yuzpe regimen. Delay in the onset of menstruation did not decrease patient acceptability.

Adult↗
PubMed1996

[Emergency contraception with mifepristone and anordrin].

OBJECTIVE: To study the efficacy of mifepristone or with anordrin for emergency contraception. METHODS: 300 healthy women were recruited within 7.2 hours after unprotected intercourse or contraceptive failure and randomly allocated into 3 groups. Group 1 (n = 100), mifepristone 25 mg twice with 12 hours apart; group 2 (n = 99), single dose of mifepristone 25 mg; and group 3 (n = 101), mifepristone 25 mg and anordrine 7.5 mg given once. RESULTS: No pregnancy occurred in group 1, while 1 pregnancy in each group 2 and 3. The contraceptive effectiveness were 100.0%, 83.8% and 86.1% for the 3 groups respectively. The overall menstruation disturbances and side effects were low. CONCLUSIONS: Both mifepristone 50 or 25 mg were effective for emergency contraception and no synergetic effects of anordrin in combination with mifepristone was shown in this study.

Adult↗
PubMed2003

Is Cerazette the minipill of choice?

Around 5% of women aged 16-49 years in Great Britain use a progestogen-only pill (POP; 'minipill') as contraception. These pills are used as alternatives to combined oral contraceptives (COCs), compared to which they are less reliable at preventing pregnancy: the estimated contraceptive failure rate of POPs is 0.5 pregnancies per 100 woman-years when used consistently and correctly, compared with 0.1 per 100 woman-years for COCs. Cerazette (Organon), a new POP, is being promoted by the company as "the first oestrogen free pill to consistently inhibit ovulation", as having "the efficacy of a combined pill, with the reassurance of an oestrogen free pill" and offering "reliable contraception for women of any reproductive age". Here, we consider whether Cerazette offers advantages over established POPs.

Adolescent↗
PubMed1987

Effect of estradiol-filled polydimethylsiloxane subdermal implants in adult male rats on the reproductive system, fertility, and progeny outcome.

Combinations of testosterone and estradiol have been proposed as potential male contraceptives. For any compound to be an acceptable male contraceptive, it must be demonstrated either to prevent pregnancy completely or, if contraceptive failure occurs, to not have any adverse effect on pregnancy outcome. We have previously established that increasing doses of testosterone given via subdermal implants to adult male rats will decrease spermatogenesis and fertility but will not result in an increased incidence of pre- or postimplantation loss or in abnormal progeny. In the present study, we have monitored the effects of a dose of estradiol that has been proposed for the contraceptive regimen, as well as doses three and seven times as large, on progeny outcome. Adult male Sprague-Dawley rats received s.c. implants of estradiol-filled polydimethylsiloxane capsules of varying lengths and, after three months, were each mated twice to two females in proestrus. The smallest dose of estradiol (the dose used in the contraceptive formulation) did not have any significant effects on any of the measured parameters of the male reproductive system, or on the incidence of pre- or postimplantation loss or on progeny outcome. With increasing doses of estradiol, there was a marked reduction in fertility. This reduction in fertility was not associated with a sufficient decrease in epididymal sperm reserves to account for the decrease in number of females impregnated, but was associated with a major reduction in seminal plugs; this would suggest that the large doses of estradiol were decreasing male sexual behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Absence of effects from immunocontraception on seasonal birth patterns and foal survival among barrier island wild horses.

Despite a large body of safety data, concern exists that porcine zonae pellucidae (PZP) immunocontraception--used to manage wild horse populations--may cause out-of-season births with resulting foal mortality. Our study at Assateague, Maryland indicated the effects of immunocontraception on season of birth and foal survival between 1990 and 2002 on wild horses from Assateague Island. Among 91 mares never treated, 69 (75.8%) of foals were born in April, May, and June (in season). Among 77 treated mares, 50 (64.9%) were born in season. Of 29 mares foaling within 1 year after treatment (contraceptive failures), 20 (68.9%) were born in season. Of 48 mares treated for greater than 2 years then withdrawn from treatment, 30 (62.5%) of 48 foals were born in season. There were no significant differences (p <.05) between either treatment group or untreated mares. Survival did not differ significantly among foals born in or out of season or among foals born to treated or untreated mares. Data indicate a lack of effect of PZP contraception on season of birth or foal survival on barrier island habitats.

Animals↗