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Minnesota: PP unit may continue to provide contraceptives to most minors.

Pending a full trial, Planned Parenthood of Minnesota may continue to provide minors with contraceptive information and supplies without parental consent unless a minor's parents specifically notify Planned Parenthood that they do not wish their child to receive such services, a Minnesota district court judge ruled on January 16. Maley, et al. v. Planned Parenthood of Minnesota, Inc., Minnesota District Court, Third Judicial District, File No. 37769. 6 couples brought a class action suit against Planned Parenthood on behalf of all Minnesota parents of unemancipated minors to enjoin Planned Parenthood from providing contraceptive services to minors without parental consent. A 1971 law permits a minor to consent to medical treatment if he or she is living apart from and financially independent of his or her parents, is married, or has borne a child and in an emergency. In addition, any minor may consent to diagnosis and treatment of "pregnancy and conditions associated therewith" and venereal disease.

Adolescent↗

The use of triphasic oral contraceptives in a continuous use regimen.

OBJECTIVE: The objective of this study was to describe the characteristics of and outcomes and side effects in patients using triphasic oral contraceptives (OCs) in a continuous use regimen. METHODS: A retrospective review of patient charts from four community-based physician practices was conducted. All patients had been using triphasic OCs in a continuous regimen (i.e., to prevent withdrawal bleeding) for a planned duration of at least three 28-day cycles. Data collected through retrospective chart abstraction included demographic and clinical indicators, duration of and reason for continuous triphasic OC use, prior OC history and side effect incidence and treatment. RESULTS: Forty-three patients meeting the inclusion criteria had data of sufficient quality to be included in all analyses. These patients represented 603 total cycles. Nearly half of the patients (49%) indicated that their primary reason for continuous OC use was personal preference rather than medical reasons. More than half of the patients (56%) had previously used triphasic OCs in a noncontinuous regimen; 24% had no prior OC experience. The median duration of continuous use was 237 days (including right-censored patients; range, 55-994). Of the 39% of patients who terminated continuous use, the most common reason given was the desire to become pregnant (35%). Sixty-one percent of the patients reported no side effects from continuous use. The most common side effect occurring beyond Day 21 of continuous use was breakthrough bleeding (reported in four patients). Survival analysis indicated that time on continuous triphasic use was positively related to parity >0 (p<.05) and the absence of side effects (p<.1). CONCLUSION: The data suggest that successful continuous use is feasible with triphasic OCs, with few adverse side effects.

Adolescent↗

Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis.

OBJECTIVE: To evaluate the efficacy and safety of cyproterone acetate versus an oral contraceptive in the treatment of endometriosis-associated recurrent pelvic pain. DESIGN: Randomized controlled trial. SETTING: Academic center. PATIENT(S): Ninety women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis. INTERVENTION(S): Six months of continuous treatment with oral cyproterone acetate, 12.5 mg/d, or an oral contraceptive containing ethinyl estradiol, 0.02 mg, and desogestrel, 0.15 mg. MAIN OUTCOME MEASURE(S): Degree of satisfaction with therapy. RESULT(S): Six patients in the cyproterone acetate arm and nine in the oral contraceptive arm withdrew because of side effects (n = 9), treatment inefficacy (n = 4), or loss to follow-up (n = 2). At 6 months, dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain scores were substantially reduced, and significant improvements were observed in health-related quality-of-life, psychiatric profile, and sexual satisfaction; no major between-group differences were seen. Subjective and metabolic side effects were limited. According to an intention-to-treat analysis, 33 of 45 (73%) of patients in the cyproterone acetate group and 30 of 45 (67%) in the oral contraceptive group were satisfied with the treatment received. CONCLUSIONS: Both cyproterone acetate and a continuous monophasic oral contraceptive were effective, safe, and inexpensive therapy for recurrent pain after conservative surgery for endometriosis.

Adult↗

Ceylon: continuing practice of contraception by acceptors of oral contraceptives and intrauterine devices in a field programme.

A follow-up study of oral-contraceptive and intrauterine-device acceptors in the early years of the Ceylon family planning programme was undertaken to determine the effect of a 1968 policy decision to cut the per cycle price of oral contraceptives by half and to allow nonclinical prescription and distribution of the pills by trained field midwives under medical supervision. While pill acceptance increased, study findings suggest that continuation did not. On balance, the intrauterine device proved much more effective than oral contraceptives in preventing unplanned pregnancies, reflecting the higher continuation rates of IUD acceptors. Although the availability of both methods clearly contributed to expansion of the programme, the demographic and administrative implications of initial choice of method, and the finding that pregnancy rates for pill users are not lower than for IUD wearers, suggest the need for more realistic counselling by clinic and field staff at the time of choice.

Adult↗

Pituitary function is altered during the same cycle in women with polycystic ovary syndrome treated with continuous or cyclic oral contraceptives or a gonadotropin-releasing hormone agonist.

OBJECTIVE: To determine if continuous oral contraceptive (OC) therapy was superior to a cyclic regimen in achieving persistent pituitary suppression of LH in patients with polycystic ovary syndrome (PCOS). DESIGN: Fourteen women (ages 16 to 41 years) with PCOS received one of three treatment groups: continuous OC therapy (30 micrograms ethinyl E2 plus 150 micrograms desogestrel), cyclic OC therapy, or monthly injections of a GnRH agonist (GnRH-a, leuprolide acetate depot 3.75 mg) for 3 months. Basal hormone levels were obtained before initiating therapy, on days 15 to 17 of the 3rd month of treatment (study 1) and again on days 26 to 28 of the 3rd month (study 2). A GnRH stimulation test was also performed during study 1 and study 2. RESULTS: After 3 months of treatment, LH levels were decreased significantly in all groups with less effective suppression observed in the cyclic OC group compared with the continuous OC or GnRH-a groups. A significant rise in LH was found only in the cyclic OC group after 5 to 7 days of placebo treatment (study 1 versus study 2). An increase in T was also observed in the cyclic OC group during study 2, whereas the continuous OC and GnRH-a groups showed continued inhibition of T levels. Although there was no significant difference in LH area under the curve (AUC) measurements after GnRH stimulation in study 1 versus study 2, the LH AUC was significantly greater in both studies in the cyclic OC group compared with the continuous OC or GnRH-a groups. CONCLUSIONS: Increased LH secretion during the week of placebo in the cyclic OC group was associated with a concomitant increase in T. The striking rise in LH secretion after GnRH stimulation in the cyclic OC group may represent increased pituitary sensitivity in patients receiving cyclic OCs regardless of the phase of the treatment cycle, perhaps secondary to increased pituitary stores of LH in these women.

Adolescent↗

Five-year experience with Norplant implants in Assiut, Egypt.

This report describes the five-year experience of the first 250 acceptors of NORPLANT implants in Assiut, Egypt. The five-year net continuation rate was 58.6 per 100 women. The five-year net cumulative pregnancy rate was 1.6 per 100 women. About three-fourths of those who continued use of this contraceptive through the fifth year reported having regular cycles. There was definite improvement in the bleeding pattern with time. The five-year net termination rate because of bleeding problems was 17.7 per 100 women. After 5 years of NORPLANT use there was a slight, statistically insignificant increase in weight, systolic and diastolic blood pressures. Of those who used contraceptives after the end of the five-year term of NORPLANT, about one-third opted to have reinsertion of the implants for a second term. About 96% of those who used NORPLANT through the fifth year reported that their experience with the contraceptive had been satisfactory.

Adult↗

Continuation and effectiveness of programme and non-programme methods of family planning in Sri Lanka.

"The objective of this paper is to examine continuation and effectiveness of contraception based on a 1986 survey of more than 3,200 women in rural Sri Lanka. Data on both programme and non-programme methods of contraception are analyzed. Programme methods are defined as including all those methods that are provided through the public or private family planning programmes (namely, oral pills, IUDs, injectables, condoms, female barrier methods and sterilization). Non-programme methods refer to those that are not provided through any structured programme; these methods include calendar rhythm (commonly referred to as 'safe period' in Sri Lanka), withdrawal, abstinence and other traditional methods."

Asia↗

Continuation and compliance of contraceptive use.

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

Contraception↗

Continuation rates among injectable contraceptive users.

Few published data exist on the ongoing use of depot medroxyprogesterone acetate, the injectable contraceptive. Women who obtained the injectable from Planned Parenthood of the Rocky Mountains between January 1993 and March 1995 were followed to ascertain continuation rates for the method. Of the 5,178 women who received an initial injection, only 57% returned for a second administration; 63% of those who returned for their second injection went on to receive a third. The overall one-year continuation rate was 23%. No significant differences in continuation rates were found based on age, race or payment type.

Adolescent↗

Contraceptive action of continuous low doses of norgestrel.

Norgestrel in a dose of 50 mug. was administered daily to 188 women during 2,250 menstrual cycles. Only two pregnancies occurred because of failure of the method, giving a failure rate of 1.1 pregnancies per 100 woman-years. The method was acceptable to most of the subjects, and side-effects, other than menstrual irregularity, were minimal; 68% of the cycles were 28 +/-5 days in length and 21% were less than 23 days. There did not appear to be any increased incidence of amenorrhoea. The antifertility action of continuous administration of low doses of progestogen may be due to an effect on corpus luteum function, in addition to the effects on cervical mucus, endometrium, and tubal transport of ova. The optimum dose of norgestrel appears to be in the range of 50-75 mug./day.

Adolescent↗