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PubMed1991

Effect of antibiotics on oral contraceptive efficacy.

It is estimated that there are currently 10 million women in the United States who are 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 has been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics. Because of the common practice of prescribing antibiotics in dentistry, oral healthcare providers should be aware of the possibility of oral contraceptive failure with antibiotic treatment. Since it is often the dental hygienist who interviews patients and assists them in completing their health questionnaire, she or he can play an important role in educating and counseling these patients in possible drug interactions. 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 oral health management of women taking oral contraceptives and other prescribed drugs.

Anti-Bacterial Agents↗
PubMed2006

Contraception at the time of abortion: high-risk time or high-risk women?

BACKGROUND: Despite the widespread use of highly effective contraception in France, the incidence of abortion is high. A retrospective population-based cohort study was designed to analyse women's contraceptive history. METHOD: We compared the contraceptive use of 163 women, whose last pregnancy ended in abortion, 6 months before, at the time of, 1 month and 6 months after the event with that of 1787 women who had never had an abortion. RESULTS: A total of 46% of women who experienced an abortion used a highly effective form of contraception 6 months before the event (versus 76% among women who had never had an abortion, P < 0.001). This proportion dropped to 33% at the time of the abortion and increased to 71%, 1 month after. In addition, 50% of women who had an abortion had changed their contraceptive method in the 6 months before the event (compared with 16% in the 6 months before the interview in women who had not had an abortion, P < 0.001). Women with socially deprived backgrounds were less likely to use a highly effective contraception after an abortion. CONCLUSIONS: Abortion is a good opportunity for intervention, but especially so for socially disadvantaged women. It is essential to draw the attention of prescribers and women to the higher risk of contraceptive failure at the start of use of a method.

Abortion, Spontaneous↗
PubMed2002

Unsafe abortion: an avoidable tragedy.

An estimated 60 000-70 000 women die annually from complications of unsafe abortion and hundreds of thousands more suffer long-term consequences which include chronic pelvic pain and infertility. The reasons for the continuing high incidence of unwanted pregnancy leading to unsafe abortion include lack of access to, or misuse of and misinformation about, effective contraceptive methods, coerced sex which prohibits women from protecting themselves, and contraceptive failure. Unsafe abortion is closely associated with restrictive legal environments and administrative and policy barriers hampering access to existing services. Vacuum aspiration and medical methods combining mifepristone and a prostaglandin for early abortion are simple and safe. For second trimester abortion, the main choices are repeat doses of prostaglandin with or without prior mifepristone, and dilatation and evacuation by experienced providers. Strategies for preventing unsafe abortion include: upgrading providers' skills; further development of medical methods for pregnancy termination and their introduction into national programmes; improving the quality of contraceptive and abortion services; and improving partner communication.

Abortifacient Agents↗
PubMed2005

An assessment of the first 3 years' use of Implanon in Luton.

OBJECTIVES: Implanon was introduced in the UK in September 1999. We present here the results of our first 106 Implanon insertions, performed over a period of 18 months. The aims of the study were to study the clinical and demographic profile of Implanon users, to assess the continuation rates of Implanon in the local population, and to identify the reasons for removal. METHODS: This was a case note-based study in which the data were transferred to a standardised pre-tested proforma. RESULTS: The age range of the 106 Implanon users was 15-43 years. Eighty-six of these clients had their Implanon removed and the Implanon status of 20 clients is not known since they were lost to follow-up by our service. Of these 86 cases, 26 had completed the full 3-year period; therefore, the continuation rate at 3 years was 30.2%. The continuation rate at the end of 1 year was 69.8% and at 2 years was 44.1%. Of the 60 women who had their Implanon removed before the recommended 3-year period, the most common reason was for bleeding irregularity (24 cases, 40%). CONCLUSIONS: This is the first published study set in the UK within a real-life setting to follow up a cohort of Implanon users for the full 3-year period. No contraceptive failures were found, replicating previous clinical trials. The continuation rate in this real-life situation was quite low compared to clinical trials. This is frequently the case when comparing real-life situations with clinical trials and may be in part due to higher motivation on the part of clinical trial participants.

Adolescent↗
PubMed2004

Implant contraception in Singaporean women: one decade of experience in KK Women's and Children's Hospital.

INTRODUCTION: The aim of this study was to assess user acceptability and effectiveness of implant contraception in Singaporean women. METHODS: A prospective study was carried out on 553 patients who received Norplant implant in our hospital from 1 January 1992 to 31 December 2000, and followed-up till 15 July 2003. The patients' profile, side-effects, satisfaction and continuation rate of Norplant implant were studied. RESULTS: The mean age of the subjects was 29.4 (plus or minus 5.1) years. The mean parity was 2.1 (plus or minus 1) live births. More than one-half (55.2 percent) of the subjects had used other methods of contraception before. The main reason for them to switch to implant contraception was convenience (63.6 percent). Of the 516 users on follow-up, the common side-effects were menstrual irregularity (51 percent), secondary amenorrhoea (9.6 percent) and weight gain (15.7 percent). 29.3 percent of users did not experience any side-effect. There was only one contraceptive failure, which may be related to drug interaction. The Pearl Index was 0.054 per hundred women years. There was only one serious adverse event of a patient (0.2 percent) who developed severe hypertension requiring treatment. The continuation rate was 92.4 percent after one year, 80.8 percent after two years, 68.9 percent after three years and 58.5 percent after four years. The main reasons for early implant removal were side-effects and desire for future pregnancy. Re-insertion was carried out in 53.7 percent of users who had completed five years of Norplant contraception. CONCLUSION: This largest sub-dermal hormonal implant contraception study in multi-racial Singapore showed that Norplant contraception had a high degree of effectiveness with relatively high user satisfaction and continuation rate.

Adult↗
PubMed2000

Time trends in biological fertility in Britain.

BACKGROUND: There is evidence of a decline in semen quality in some countries, including Britain, in recent decades. This retrospective cohort study examined the hypothesis that biological fertility had also declined. The trend in couple fertility was assessed by means of time to pregnancy (TTP--a sensitive and validated measure of fertility. METHODS: A representative sample of the British population aged 16-59 years was surveyed. TTP was obtained for all births conceived after unprotected intercourse that began during 1961-93, excluding contraceptive failures. The sample size was 1540. FINDINGS: In contrast to the original hypothesis, this study found that fertility has increased; the rising trend was accompanied by slight dips during 1976-80 and 1986-90. These results were consistent between male and female respondents, and undiminished by adjustment for possible confounding factors. A stronger and more consistent relation was found with the year when unprotected intercourse started (a period effect) than with the year of birth of either partner (a birth cohort effect). INTERPRETATION: The findings could not be explained by trends in age at first birth, increased treatment of subfertility, or changes in oral contraceptive use. If a decline in male fertility has occurred, it has been more than compensated for by a countervailing increase in couple fertility.

Adolescent↗
PubMedDate not supplied

Prospects for increased contraceptive pill use in Japan.

Although oral contraceptives are not commercially available in Japan, a low-dose contraceptive pill is expected to become available soon. The current rate of pill use is less than 1 percent, but recent survey data indicate that about 10 percent of currently married women of reproductive age intend to use the pill when it comes on the market. Those who favor the pill do so because it is highly effective in preventing unwanted pregnancies, and because it reduces the need for abortions. Many other women report uncertainty about the pill because of concern about side effects. Given that Japan has a contraceptive failure rate of about 25 percent, with 29 percent of women having had at least one abortion, many women who do not yet favor the pill may shift to it once the low-dose pill comes on the market and they are reassured about its safety. Thus, the rate of pill use is likely to rise well above 10 percent.

Adult↗
PubMed1997

Multicenter, double-blind, comparative clinical study on the efficacy and acceptability of a monthly injectable contraceptive combination of 150 mg dihydroxyprogesterone acetophenide and 10 mg estradiol enanthate compared to a monthly injectable contraceptive combination of 90 mg dihydroxyprogesterone acetophenide and 6 mg estradiol enanthate.

Healthy, regularly menstruating women, aged 14-38 years, were enrolled in a comparative, double-blind, phase III, clinical trial to evaluate the contraceptive efficacy and acceptability of a combination of 90 mg dihydroxyprogesterone acetophenide with 6 mg estradiol enanthate compared to the commercially available contraceptive combination of 150 mg dihydroxyprogesterone acetophenide with 10 mg estradiol enanthate. Subjects received the contraceptive combination intramuscularly, between the 7th and 10th day of each menstrual cycle, during 12 consecutive menstrual cycles. Approximately 60% of the subjects in both groups completed the study. Principal reasons for discontinuation were personal, nonmedical reasons. Principal medical reasons for discontinuation were menstrual-related, irregular bleeding being the most frequent. Differences in menstrual patterns between the two groups did not lead to differences in discontinuation rates. Three contraceptive failures occurred during the trial, one in Group A (90/6 mg) and two in Group B (150/10 mg), indicating that the lower dose formulation is at least as efficient as the higher dose.

Adolescent↗
PubMed1994

Comparison of adolescent and adult experiences with Norplant levonorgestrel contraceptive implants.

OBJECTIVE: To compare acceptability, tolerance of side effects, and continuation rates among adolescent and adult Norplant accepters. METHODS: An 18-month observational study was conducted of 136 adolescents and 542 adults who received Norplant at the Francis Scott Key Medical Center in Baltimore, Maryland. Data were collected from the following: a self-administered history form completed at the preinsertion visit, a self-administered follow-up form completed at routine follow-up visits, problem-visit chart review, and telephone contact for patients noncompliant with follow-up appointments. RESULTS: The adolescents ranged in age from 13-18 years (mean 16.4), and adults ranged in age from 19-46 (mean 24.7). The mean parity among teenagers was 1.4; among adults, 3.2. Thirty-nine percent of teenagers and 64% of adults had had one or more therapeutic abortions. Forty percent of adolescents and 47% of adults reported at least one contraceptive failure in the past. Both adolescent and adult Norplant accepters made few telephone calls or problem visits because of complaints or side effects. Compliance with routine annual follow-up was poor for adolescents (24 of 136, 18%) and adults (72 of 542, 13%). Follow-up of noncompliant patients revealed low rates of implant removal. Fifteen adolescents (11%) and 60 adults (11%) had Norplant removed. The most common reasons for removal included irregular bleeding, weight gain, headaches, and desire for pregnancy. CONCLUSIONS: Implant acceptability, continuation, and tolerance of side effects were high and comparable among adolescent and adult accepters. Initial implant users were primarily adolescents or adults who had experienced problems with other forms of reversible contraception. Adherence to scheduled follow-up appointments was poor, regardless of age.

Adolescent↗
PubMed2002

Antiepileptic drugs: coprescription of proconvulsant drugs and oral contraceptives: a national study of antiepileptic drug prescribing practice.

OBJECTIVES: To determine the frequency of coprescription of antiepileptic drugs (AEDs) and drugs with proconvulsant potential and of coprescription of AEDs and low dose oral contraceptives. METHODS: Using information from all 294 fully computerised general practices participating in the General Practice Research Database who entered complete data in 1995, persons were identified who had a prescription for an antiepileptic drug and who had a diagnosis of epilepsy or epileptic seizures in their medical records. Other medication was also recorded. RESULTS: Of women with epilepsy aged 15-45, 16.7% were on the oral contraceptive pill and of 200 on both an enzyme inducing AED and an oral contraceptive, 56% were on formulations with an estrogen content less than 50 microg. This will be associated with increased risk of contraceptive failure and unwanted pregnancy. Over 10% of all AED prescriptions in adults were associated with simultaneous prescription of at least one drug with a potential proconvulsant effect. CONCLUSIONS: Prescribers should be alert to the possibility of pharmacodynamic and pharmacokinetic interactions between AEDs and other medication. With the aging of the population of people with seizures, and the polypharmacy often associated with old age, the likelihood of adversely interacting drug combinations will increase.

Adolescent↗
PubMed1986

The lack of effect of sodium valproate on the pharmacokinetics of oral contraceptive steroids.

Patients taking anticonvulsants such as phenobarbitone, phenytoin and carbamazepine together with their oral contraceptive steroid may suffer contraceptive failure because of the enzyme-inducing properties of these anticonvulsants. We have examined, in six women, the effect of sodium valproate, an effective broad spectrum anticonvulsant, on the area under the plasma concentration versus time profile (AUC) of ethinyloestradiol (EE2) and levonorgestrel (Ng). Prior to sodium valproate therapy the mean AUC for EE2 was 880 +/- 109 pg/ml X h (+/- S.E.) and for levonorgestrel it was 29.1 +/- 2.9 ng/ml X h (n = 4). Between two and four months after sodium valproate therapy the mean AUC figures had not changed significantly, the figure for EE2 being 977 +/- 130 pg/ml X h and for levonorgestrel 29.2 +/- 1.9 ng/ml X h (p greater than or equal to 0.1 in each case). We conclude that sodium valproate in the dose used (200 mg b.d.) does not interact with oral contraceptive steroids.

Adolescent↗
PubMed2002

A randomized comparative study on mifepristone alone and in combination with tamoxifen for emergency contraception.

The purpose of the clinical study was to compare the efficacy and side effects of 10 mg of mifepristone alone (Group 1) and with 20 mg of tamoxifen (Group 2) for emergency contraception, especially as used within 72-120 h after coitus. Four-hundred female volunteers with one act of unprotected intercourse or contraception failure (200 cases in each group) were recruited and completed the study. There were 198 women treated < 72 h after coitus (100 in Group 1 and 98 in Group 2), whereas the remaining 202 patients were treated between 72-120 h (100 in Group 1 and 102 in Group 2). In total, four pregnancies occurred; one treated < 72 h in each group, two between 72-120 h in Group 1. Efficacy for prevention of unwanted pregnancy by Trussell method is 84% for Group 1, and 95% for Group 2, and which is not significantly different between the two groups and even subgroups. The side effects (15.5% for Group 1 and 14.5% for Group 2) and changes in menstruation were infrequent and mild in both groups. Further studies should be conducted to determine whether tamoxifen combined with mifepristone for emergency contraception is more effective as compared with mifepristone alone.

Adult↗
PubMed1975

Menstrual regulation in family planning services.

Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.

Abortion, Induced↗
PubMed1994

Method switching and not using modern methods lead to abortions in Mauritius.

Contraceptive prevalence in Mauritius (76%) is among the highest in the world. Yet, it is estimated that each year there are some 20,000 cases of induced abortion, which is illegal in the country. A study based on a sample of 475 women admitted to three hospitals with complications due to induced abortion revealed considerable use of unreliable methods (e.g., withdrawal and natural methods), frequent method switching, and inconsistent use of modern methods. The study also found that women seeking abortion were usually under 30 years of age, and 20% of women with abortion complications were not using any method, and some 50% were using an unreliable method at the time they became pregnant. It emerged that with increasing numbers of women employed, their work schedules hindered their going to a family planning clinic and resulted in abortion being used as a back-up to contraception failure. Among the women with abortion complications, 25% had already had a previous abortion. These findings came as a big surprise to the family planning services. To discuss the findings, a national symposium was held in July, 1993. The symposium was attended by government ministers, members of parliament, and international personalities in the field of family planning. A discussion of the results of the study also took place in the National Assembly, where a motion was tabled to decriminalize abortion. The findings also facilitated, albeit indirectly, the approval of Norplant in the country.

Abortion, Induced↗
PubMed2001

Characteristics of Pakistani women seeking abortion and a profile of abortion clinics.

A study of the characteristics of Pakistani women seeking abortion and a profile of abortion clinics was conducted in 32 abortion clinics in three provincial capitals of the country. All 452 women who had their pregnancies terminated between October and December 1997 were interviewed. Except for 39 women (8.6%), all study subjects were married. A majority of the women (36.6%) were aged >35 years, 61.0% had given birth to > or =5 children, and 40.2% were illiterate. The predominant reasons for abortion were "too many children" (64.4%), contraceptive failure (20.3%), premarital affairs (8.6%), medical reasons (5.4%), and extramarital affairs (1.3%). Nearly two thirds of the abortions were induced by inadequately trained persons. Only 22% of the abortion clinics met the World Health Organization (WHO) standards required for safe termination of pregnancy. At all these clinics, the procedure used to terminate the pregnancy was dilatation and curettage (D&C). Only one clinic was using manual vacuum aspiration (MVA). Induced abortion seems to be fairly common among married women of high parity, advanced age, and low educational status. Keeping in view the large number of terminations, new medical and surgical techniques of pregnancy termination should be introduced to those already providing abortion services.

Abortion, Therapeutic↗
PubMed2004

Reproductive health effects and teratogenicity of antiepileptic drugs.

Women with epilepsy are less likely to bear children than women in the general population, and although this reduced fertility can be attributed in part to effects of the disease itself, the effects of antiepileptic drugs (AEDs), including changes in reproductive endocrine function, are also a factor. Conversely, some AEDs interact with oral contraceptives and can increase the risk for contraceptive failure and unplanned pregnancy. Women with epilepsy also have elevated rates of congenital anomalies and major malformations in their offspring, for which exposure of the developing fetus to AEDs taken by the mother appears to be responsible. In utero exposure to some AEDs may also be associated with increased risk for impaired cognitive function in the growing child. Clearly, possible long-term effects on reproductive health and pregnancy outcomes require careful attention when AED therapy is being considered for a patient with childbearing potential. Moreover, because AEDs are increasingly being used in therapy for other conditions such as migraine, bipolar disorder, and pain, it is not only the treatment of women with epilepsy that will be affected by these concerns.

Abnormalities, Drug-Induced↗
PubMed2004

Can changes in sexual behaviors among high school students explain the decline in teen pregnancy rates in the 1990s?

PURPOSE: To explore the utility of using national data from high school students to explain changes in national declines in pregnancy rates. Although declines in teen pregnancy and birthrates in the 1990s have been welcome news to those interested in adolescent health and welfare, the reasons for these declines are not readily apparent. Previous attempts to explain these declines focused on the period before 1995 and did not directly calculate the impact of improved contraceptive use. METHODS: The national Youth Risk Behavior Survey provided estimates for sexual activity and contraceptive use among teens aged 15-17 years between 1991 and 2001 (n = 31,058). These data were combined with method-specific contraceptive failure rates (CFRs) derived from the 1988 and 1995 National Survey of Family Growth and pregnancy rates from the National Vital Statistics System. We calculated weighted-average CFRs (WACFR) and used the annual rate of change in the WACFR and sexual activity to estimate their relative contributions to the annual change in risk of pregnancy. Weighted least-squares regression in SUDAAN was used to test change over time. RESULTS: Between 1991 and 2001, annual rates of change in sexual behaviors were -1.7% for sexual experience and -1.6% for the WACFR. Improvements in WACFR resulted primarily from a decline in use of withdrawal (from 20% to 13%) and use of no method (from 17% to 13%) and an increase in condom use (40% to 51%). Recent sexual intercourse (i.e., intercourse during the past 3 months among teens who had ever had intercourse) did not change over time. The change in the estimated risk of pregnancy closely approximated the annual decline in the pregnancy rates for blacks and Hispanics but underestimated the actual decline for whites. Overall, 53% of the decline in pregnancy rates can be attributed to decreased sexual experience (95%CI 26% to 79%) and 47% to improved contraceptive use (95%CI 21% to 74%). CONCLUSIONS: Use of school-based behavior data reflects well the pregnancy experience for school-age black and Hispanic adolescents, but does not track well with the pregnancy risk of white adolescents. Care should be taken in attributing changes in pregnancy rates to changes in behavior, given broad confidence intervals around these estimates. These data suggest that both delayed initiation of sexual intercourse and improved contraceptive practice contributed equally to declines in pregnancy rates among high school-aged teens during the 1990s; however, estimates varied among racial and ethnic groups.

Adolescent↗
PubMed1996

Epilepsy in women.

Physicians should be aware of certain gender-related issues in the treatment of women with epilepsy. Although in the past reproduction was discouraged in women with epilepsy, more than 90% of the pregnancies in such patients currently have an uneventful outcome with appropriate management. Oral contraceptive agents are not contraindicated in women with epilepsy; however, the contraceptive failure rate increases fourfold if patients are being treated concurrently with enzyme-inducing antiepileptic drugs. In pregnant patients, free drug levels of carbamazepine, phenobarbital, phenytoin, and valproate may change because of alterations in protein binding, clearance, and possible absorption. The dosage should be adjusted if the patient's seizures are increasing. Women with epilepsy may have disease-related or treatment-related menstrual dysfunction, complications of pregnancy (slightly increased risk of toxemia and fetal loss), endocrine dysfunction, appearance changes (a general coarsening of facial features with long-term administration of antiepileptic agents), and psychosocial maladjustment. Some effects are drug specific. Although control of seizures remains the primary goal of treating women with epilepsy, the widening choice of antiepileptic drugs may facilitate optimal management of secondary and gender-specific complications.

Anticonvulsants↗