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Clinical experience with Progestasert beyond one year of use.

A total of 254 women were enrolled in the study of the intrauterine progesterone system, Progestasert, and some of the subjects have been followed into the 8th year of use of the device. Clinical experience on 192 women in their 1st year of use of the device was reported in 1977. This follow-up study reports on 110 patients who had at least 2 insertions of the Progestasert for continuous use of 13 months, to a maximum of 8 insertions for continuous use of up to 86 months, for a total of 3808 months. 60% of subjects were nulliparous women who tolerated the device as well as the multiparous. The expulsion rate was low (3.5/100 women-years) noting that 82% of expulsions occurred within 2 months postinsertion or exchange of the device. A total of 7 pregnancies were observed; the pregnancy rate was 2.2/100 women-years. 2 of these 7 pregnancies were ectopic. No uterine or cervical perforations and no serious infections were observed.

Age Factors↗

Antecedents of adolescent initiation of sex, contraceptive use, and pregnancy.

OBJECTIVE: To identify the most important antecedents associated with adolescent initiation of sex, contraceptive use, and pregnancy. METHODS: Statistically significant antecedents in more than 250 studies were identified and summarized. RESULTS: More than 100 antecedents create a complex and detailed picture of the correlates of adolescent sexual behaviors. They describe characteristics of the adolescents themselves, their partners, peers, families, schools, and communities, as well as relationships to these entities. They included antecedents that were inherently sexual and nonsexual. CONCLUSIONS: To reduce teen pregnancy substantially, multiple sexual and nonsexual antecedents in different clusters may need to be addressed.

Adolescent↗

Epidemiological studies of natural family planning.

The prevalence of the use of natural family planning (NFP) can be estimated from sample surveys of married women in the reproductive ages (MWRA). Surveys in developed and developing countries during the past decade indicate that the prevalence of NFP use varies from 0 to 11%. In addition, if one considers NFP use in relation to other contraceptive methods, the percentage of all current contraceptors who use NFP varies from 1 to 35%. This suggests that NFP is an important method in certain countries. Pregnancy rates for NFP vary widely, but most reliable studies report 1-year life-table pregnancy rates between 10 and 25/100 woman-years. The Billings ovulation method consistently has higher pregnancy rates than the sympto-thermal method and NFP users generally have among the highest pregnancy rates compared to other methods. The major safety issue concerning NFP is the risk of adverse pregnancy outcomes associated with aged gametes. There are suggestions from a number of investigations that conceptions distant from ovulation have a higher risk of spontaneous abortion and a higher proportion of male births. The findings with respect to birth defects or multiple pregnancies are less consistent, although some studies have reported an increased risk of chromosomal anomalies.

Abortion, Spontaneous↗

Rapid determination of vitamin A (retinol) and vitamin E (alpha-tocopherol) in human serum by isocratic adsorption HPLC.

The simultaneous determination of alpha-tocopherol and retinol in human serum is reported. The separation is carried out by means of isocratic HPLC on adsorption columns. UV-Detection is possible by using either one wavelength for both compounds (300 nm), or after a lambda change mode with typical wavelengths for alpha-tocopherol (292 nm) and retinol (325 nm). According to short retention times (10 min) and rapid extraction the method is useful for clinical research and allows about 50 analyses per day and operator. Blood from 176 human volunteers was collected and alpha-tocopherol and retinol levels in serum determined with this method. Statistical evaluation of different selected groups shows typical significant differences of alpha-tocopherol and retinol concentrations in smokers and oral contraceptive users.

Adsorption↗

Comparative performance of two copper IUDs: Nova-T and MLCu375.

A comparative randomized trial was made of two intrauterine contraceptive devices: Nova-T and MLCu375. The IUDs were used by 637 and 606 women, respectively, for one year, unless the device was removed earlier. The reasons for IUD removal were analyzed after one year using the life-table method. Statistically significant differences were found in expulsion and removal for bleeding and/or pain rates.

Adolescent↗

Comparison of two copper IUDs: the MLCu375 and the Nova-T.

A comparative randomized trial was carried out on two intrauterine contraceptive devices: the Nova-T and the MLCu375. The IUDs were used by 1116 and 1237 women respectively, over a period of 2 years. The reasons for IUD removal were analyzed after one and two years using the life-table method. Statistically significant differences were found in the rates for pregnancy, expulsion and removal for bleeding and/or pain favoring the MLCu375 IUD.

Adolescent↗

Administration of an antiprogesterone up-regulates estrogen receptors in the endometrium of women using Norplant: a pilot study.

OBJECTIVE: To determine the effect of a single dose of mifepristone (200 mg) on endometrial estrogen and progesterone receptors in Norplant users. DESIGN: A prospective single-blind placebo-controlled pilot study. SETTING; Women were recruited from a large family planning clinic and were studied either at the clinic or in a clinical research unit attached to a teaching hospital gynecology department. PATIENT(S): Eight women using Norplant and experiencing vaginal bleeding more often than once every 24 days. All completed the study. INTERVENTION(S): Endometrial biopsies were taken after treatment with both placebo and 200 mg of mifepristone, both given at the start of a bleeding episode. MAIN OUTCOME MEASURE(S): Expression of endometrial progesterone (PR) and estrogen (ER) receptors, ovulation, and vaginal bleeding. RESULT(S): Mifepristone administration was associated with down-regulation of PR receptor subtype B and up-regulation of ER. Women treated with mifepristone showed a tendency to increased ovulation rates and reduced vaginal bleeding. CONCLUSION(S): The effect of mifepristone on endometrial steroid receptors was consistent with functional inhibition of progesterone. The findings warrant further investigation of this regimen as a strategy to reduce frequent bleeding.

Biopsy↗

A comparative study of the hemostatic effects of two monophasic oral contraceptives containing 30 mu(g) ethinylestradiol and either 2 mg chlormadinone acetate or 150 mu(g) desogestrel.

OBJECTIVES: To determine the effect of two low-dose monophasic oral contraceptives containing either 2 mg chlormadinone acetate or 150 microg desogestrel on blood clotting and fibrinolysis. METHODS: In vivo markers of intravascular coagulatory and fibrinolytic activity were measured in 45 volunteers randomly assigned to a 6-month treatment with one of the two study preparations. RESULTS: During oral contraceptive use, the procoagulatory activity increased (increased prothrombin fragment 1+2), the anticoagulatory capacity changed (increased protein C activity, decreased activated protein C sensitivity, decreased protein S activity and decreased antithrombin III activity) and the fibrinolytic system was activated (increased concentrations of plasmin-antiplasmin complexes and D-dimer as well as total fibrin degradation products). There were no relevant differences between the two medication groups. CONCLUSION: Our results demonstrate that both oral contraceptive preparations have comparable effects on the hemostatic system. There was a shift towards a new equilibrium of hemostatic activities, both coagulatory and fibrinolytic, at a higher turnover rate. Changes did not exceed the range of normal variation and were comparable to the published effects of other low-dose oral contraceptives. There was no evidence ofa differential risk of deep vein thrombosis between the two preparations.

Adolescent↗

Dual protection in sexually active women.

OBJECTIVE: To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. DESIGN: Secondary analysis of cross-sectional household survey data. METHODS: Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. RESULTS: (i) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. CONCLUSIONS: There is an urgent need for targeted programmes that increase dual protection with condoms.

Adolescent↗

The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy.

OBJECTIVE: The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP). METHODS: The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist. RESULTS: It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental group, whereas there was no significant change for the control group. CONCLUSION: The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future. PRACTICE IMPLICATIONS: Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention.

Abortion, Legal↗