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In order to detect a possible association between exogeneous estrogens and endometrial cancer under Swedish circumstances, the previous use of estrogens among 622 cases of endometrial cancer 1974-77 has been compared with that of the average female population, represented by a randomly selected sample of 1 866 contemporaries to the cancer cases. Among women aged 50-69 years, 6-36 months of use of 'natural' and/or to a much lesser extent 'synthetic' estrogens was equally common in the two groups. However, starting in 1976, 3-6 years of use became increasingly more common among cancer cases. Taking 1974-77 together, cancer cases had been on such a long-term regimen more than 5 times as commonly as controls. Additional progestagen treatment was equally rare in the two groups. Tumors of estrogen users were of a significantly lower grade than those of non-users of the same age. While it cannot be concluded at this stage that estrogens are cocarcinogenic, the evident possibility motivates a somewhat cautious, restrictive approach to prescription. Progestagens could be added sequentially, though it is not yet verified that they abolish the association between endometrial cancer and estrogens that is now recognized by many investigators.
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Epidemiologic studies show a lower frequency of fibrocystic breast disease among users of oral contraceptives than among women who have never used them. Family history of breast cancer appears to be more common among benign breast disease patients than among their controls. To determine the use of oral contraceptives and the presence of family history of breast cancer, information was obtained from 211 cystic cases and their matched controls from the metropolitan Toronto area. Cystic cases compared to controls had a higher proportion of women with a family history of breast cancer (21% vs 15%). For both a positive and negative family history of breast cancer, as well as for all women combined, the mean duration of oral contraceptive use was lower for cystic cases than for controls. The odds ratio for oral contraceptive use according to family history of breast cancer for cystic cases and controls was 0.42 and 0.81 respectively. The possibility that a woman is more protected against benign breast disease by using oral contraceptives if she has a family history of breast cancer deserves more attention in future investigations on the long-term effects of birth control pills.
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A non-comparative study of the Norplant contraceptive subdermal implant system was conducted in Kumasi, Ghana. A total of 100 acceptors were enrolled in the clinical trial, which began in 1987. There were no pregnancies during the first two years of use. Only nine post-insertion medical problems were reported during the first two years of use. One woman in this study requested removal for menstrual pattern changes through two years of use. As assessed through user-satisfaction questionnaires administered at approximately six months of use, there has been an overall positive user experience with Norplant in this study. Although the sample size in this study is small, our results seem to be consistent with other studies and it appears that Norplant offers an effective, safe and acceptable method of contraception for Ghanaian women.
This article examines the determinants of first-time use durations of the injectable contraceptive Depo Medroxy Progesterone Acetate (DMPA) for rural Bangladeshi women. The method's side effects were defined by 200 first-time users in Matlab district during lengthy, open-ended interviews. Women with many children used the method longer than did women of low parity. Those who experienced side effects had shorter use durations than those who did not, and those who cited heavy bleeding as their main problem discontinued use soonest. Women whose husbands approved of family planning had significantly longer use durations than those whose husbands disapproved. Respondents who adopted DMPA because of perceived positive aspects of the drug used it longer than those who chose it for other reasons. Results of the study underscore the importance of viewing side effects in a specific social and cultural context. Expanded side-effects counseling for women and their husbands is needed.
In a multicentre study 882 women were treated during a total of 12,850 cycles with a new combiphasic contraceptive: CTR 24. The study period was 18 cycles. The combiphasic preparation CTR 24 contains 25 micrograms desogestrel (CAS 54024-22-5) plus 40 micrograms ethinylestradiol (CAS 57-63-6) daily for the first 7 days followed by the combination of 125 micrograms desogestrel and 30 micrograms ethinyl-estradiol daily for the subsequent 15 days. The bleeding patterns were analysed over pill cycles and a comparison was made between starters and switchers. The cycle control of the combination was very good. The side effect profile was favourable.
OBJECTIVE: To review the characteristics and experience of Australian women treated with depot medroxyprogesterone acetate (DMPA) in one gynaecological practice in Melbourne since 1973. DESIGN: A detailed retrospective review of clinical data on 363 women treated with a total of 2298 injections of DMPA over the past 20 years. RESULTS: The main indication was contraception, although a substantial minority (20%) were treated with DMPA predominantly for medical indications such as endometriosis. No pregnancy occurred within three months of an injection. There was also high acceptability, with a mean of 6.3 injections per subject, and a mean overall follow-up of 43.3 months. The median delay in the return of fertility in those wishing to conceive immediately was 9.2 months. Only one patient complained of difficulty in conceiving. Menstrual bleeding disturbances only led to 7.3% of the discontinuations, although fairly frequent use of short courses of oral oestrogen (in 40% of women) was employed in the early months of DMPA treatment. Other side effects were relatively infrequent, the most common being superficial dyspareunia or reduced libido (in 8%). CONCLUSIONS: This much maligned drug merits a legitimate place among the contraceptive choices available for Australian women. Accurate, unbiased information about the extensive worldwide experience needs to be made available to all Australian medical practitioners.
This study examines the phenomenon of contraceptive risk-taking, which is the nonuse of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking and also compared levels of contraceptive knowledge and pregnancy histories of noncontraceptors versus barrier contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger, and for those whose knowledge of the fertility cycle is incorrect, but risk-taking was found to be unrelated to the women's marital status. Noncontraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to nonuse of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a subgroup of the medically undeserved low-income population.
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When the thread of an intrauterine device cannot be seen in the cervical canal a diagnostic procedure to insure continued contraceptive effectiveness is mandatory. Hysteroscopy is the method of choice for localization of an intrauterine device even during pregnancy. Hysteroscopic removal is possible even during pregnancy. With this method we removed 16 obscure intrauterine devices and 7 devices during pregnancy. The advantages and disadvantages of other diagnostic and therapeutic methods are discussed.
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