A practical guide for prescribing birth control pills.
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Clinical Protocols↗
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The contraceptive use of Depo-Provera in U.S. adolescents.
UNLABELLED: Little is known about the use of depot medroxyprogesterone acetate (Depo-Provera, DMPA) in U.S. adolescents before the FDA approved its usage for contraception in 1992. PURPOSE: To determine the experience with DMPA use in adolescents for contraception in the United States. METHODS: A questionnaire survey was sent to U.S. physicians identified as adolescent health care providers. RESULT: DMPA had been prescribed by 41% of surveyed physicians who prescribe contraception for adolescents. Eighty-five percent of patients continued use beyond nine months and 40% continued beyond 21 months. Sixty-seven percent of physician/respondents reported using DMPA in mentally retarded patients. CONCLUSIONS: Many providers used DMPA for contraception in adolescents prior to its FDA approval for contraception. DMPA has a high rate of continuation of use as a contraception in adolescents.
Adolescent↗
Why do inadvertent pregnancies occur in oral contraceptive users? Effectiveness of oral contraceptive regimens and interfering factors.
Inadvertent pregnancies in combined pill users are not uncommon, and are usually due to errors of tablet taking. However, many factors may contribute to 'pill failure'. In this review the endocrine pharmacology of pill use and the changes reported with missed pills have been considered in detail. The influences of other factors including drug interactions have been reviewed and a series of recommendations made for reducing the risk of pregnancy in each of these circumstances.
Anti-Bacterial Agents↗
A comparative evaluation of oral contraceptive use and associated compliance issues in a rural population.
One hundred thirty-three patients were enrolled in a study designed to evaluate and compare oral contraceptive use in three rural communities. The patients averaged 31 years old (range, 13 to 49 years); 92% were white, 4.5% Hispanic, and 3% Native American. Genora, Ortho-Novum, and Triphasil were the most frequently prescribed oral contraceptives. Triphasic oral contraceptives accounted for one third (n = 64) of 203 prescriptions, and conventional monophasic preparations accounted for two thirds. Twenty percent (n = 26) of the patients studied were non-compliant. The most frequent causes of noncompliance cited were cost and inconvenience. However, generic alternatives were requested in only 43% of the cases for which generic equivalents were available. Less-expensive alternatives (eg, generic products, medroxyprogesterone acetate injection) should be advocated to deter patient noncompliance because of cost issues. Drug interactions and adverse effects were not reported in our patient population and thus did not contribute to noncompliance.
Adolescent↗
Contraceptive choices for behaviorally disordered women.
Women with psychologic disturbances of depression, anxiety, or thought disorganization pose a special management problem when providing a safe and effective means of contraception. The difficulty is compounded by the fact that many mentally disturbed women also abuse drugs. Therefore, providing contraception to the many types of behaviorally disturbed women requires the full range of contraceptive options and protection from sexually transmitted diseases. When compliance can be assured, oral contraceptives are the preferred method. When compliance is questionable, progestin implants or injections may be tried. However, progestin-only preparations are associated with several side effects, including worsening of mood in depressive patients.
Contraception↗
Considerations for contraception in women with cardiovascular disorders.
Women with hypertension, angina pectoris, or mitral valve prolapse require special considerations when selecting an appropriate method of contraception. All three effective, reversible options (oral contraceptives, intrauterine devices, or progestin implants) carry some degree of added risk for these patient populations. However, pregnancy itself presents certain risks and, in the event of contraceptive failure, certain women with these disorders are at increased risk of developing serious cardiovascular sequelae that affect both mother and fetus. These negative effects can carry far into the neonatal period. This article describes the risk/benefit profiles of the currently available contraceptive options relative to their potential impact in these compromised women.
Cardiovascular Diseases↗
A comparative analysis of three different dose combinations of oral contraceptives.
Three different low-dose formulations of oral contraceptives were compared to determine the most suitable preparation for Filipino women as reflected in the first year continuation rates, incidence of side effects and failure rates. A total of 1,800 subjects were enrolled in the study from 18 health centers in six provinces in two regions of the Philippines, covering a total of 18,282 women-months of use. Sociodemographic characteristics were comparable. The monophasic levonorgestrel group showed the best performance followed by the triphasic preparation. The norethindrone group consistently showed higher drop-out rates, which may be due to the relatively higher incidence of side effects. For all three preparations, bleeding irregularities were low. There were no major side effects and no pregnancy was reported in one year of use. Noted was a distinct regional and provincial difference in recruitment and follow-up performance, possibly due to clinic, client or program factors.
Adult↗
Efficacy, cycle control, and side effects of low- and lower-dose oral contraceptives: a randomized trial of 20 micrograms and 35 micrograms estrogen preparations.
Estrogen content represents a tradeoff between cycle control and side effects, but few direct comparisons of 20 and 30/35 micrograms preparations are available. To address this issue, we conducted a randomized, open-label multicenter clinical trial comparing Alesse (20 micrograms ethinyl estradiol [EE]), Mircette (20 micrograms EE), and Ortho Tri-Cyclen (35 micrograms EE) among 463 OC starters or switchers. Bloating, breast tenderness, and nausea were approximately 50% more common in women using 35 micrograms EE as compared to 20 micrograms EE preparations. Cycle control was similar in all products, although during the first two cycles among starters; users of Mircette and Ortho Tri-Cyclen (Tri-Cyclen) exhibited better cycle control than Alesse users. Discontinuation and pregnancy rates were not significantly higher in 35 micrograms EE users.
Adolescent↗
Oral contraceptive use by teenage women does not affect peak bone mass: a longitudinal study.
OBJECTIVE: To determine the effect of oral contraceptive pill (OCP) use during adolescence on peak bone mass. DESIGN: Longitudinal observational study. SETTING: Academic clinical research center. PATIENT(S): Sixty-two non-Hispanic, white females in The Penn State Young Women's Health Study, who were studied for 8 years during ages 12-20. INTERVENTION(S): There were 28 OCP users, who used OCPs for a minimum of 6 months and were still using at age 20, and 34 nonusers who had never used OCPs. MAIN OUTCOME MEASURE(S): Total body bone, dedicated hip bone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. RESULT(S): The OCP users and nonusers did not differ at entry in anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OCP use by the user group was 22 months. At age 20, the groups remained indistinguishable in anthropometric, body composition, total body, and hip bone measures, and in age of menarche and sports exercise scores. CONCLUSION(S): Oral contraceptive pill use by healthy, white, teenage females does not affect acquisition of peak bone mass.
Adolescent↗
Oral contraceptives and rheumatoid arthritis: further evidence for a preventive effect.
To investigate a reported negative association between the use of oral contraceptives (OC) and the development of rheumatoid arthritis, a case-control study was undertaken to compare the histories of OC use between 228 women with a diagnosis of probable or definite rheumatoid arthritis and 302 women with the diagnosis of soft-tissue rheumatism and/or osteoarthritis. The use of OCs before the onset of joint complaints was acknowledged by 31.1% of the rheumatoid arthritis patients and by 55.6% of the controls. After adjustment for possible confounding variables, the rate ratio for ever use became 0.42 (95% confidence interval 0.27--0.65), while it was 0.40 (0.22-0.72) for ex-users and 0.45 (0.28-0.75) for current users. These findings confirm the finding from the Royal College of General Practitioners Oral Contraceptive Study that the incidence rate of rheumatoid arthritis among OC users was halved.
Adult↗
Influence of psychosocial factors on adolescent compliance with oral contraceptives.
This paper prospectively tests the influence of a variety of sociomedical and psychosocial factors on compliance with oral contraceptives among adolescent females from a population at high risk for pregnancy. Fifty-six females aged 14-19 yr from a lower socioeconomic background received a battery of pretest measurements and were then given Ortho-Novum 1/35 combined with riboflavin during an initial visit and 1-, 2-, and 4-month follow-ups. Compliance was measured at each follow-up using a Guttman scale consisting of: (1) avoidance of pregnancy, (2) appointment adherence, (3) pill count, and (4) urinary fluorescence for riboflavin. Six factors were found to be significantly associated with noncompliance: (1) multiple sexual partners, (2) appointment being made by the adolescent, (3) low evaluation of personal health, (4) feelings of hopelessness, (5) worry about becoming pregnant, and (6) previous abortion. These findings suggest that certain indicators of sexual activity and social psychological status may help predict noncompliance in some adolescent females.
Adolescent↗
A survey of family planning in the Philippines.
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Adolescent↗
Stroke in users of low-dose oral contraceptives.
BACKGROUND: Previous studies have linked the use of oral contraceptive agents to an increased risk of stroke, but those studies have been limited to oral contraceptives containing more estrogen than is now generally used. METHODS: In a population-based, case-control study, we identified fatal and nonfatal strokes in female members of the California Kaiser Permanente Medical Care Program and who were 15 through 44 years of age. Matched controls were randomly selected from female members who had not had strokes. Information about the use of oral contraceptives (essentially limited to low-estrogen preparations) was obtained in interviews. RESULTS: A total of 408 confirmed strokes occurred in a total of 1.1 million women during 3.6 million woman-years of observation. The incidence of stroke was thus 11.3 per 100,000 woman-years. On the basis of data from 295 women with stroke who were interviewed and their controls, the odds ratio for ischemic stroke among current users of oral contraceptives, as compared with former users and women who had never used such drugs, was 1.18 (95 percent confidence interval, 0.54 to 2.59) after adjustment for other risk factors for stroke. The adjusted odds ratio for hemorrhagic stroke was 1.14 (95 percent confidence interval, 0.60 to 2.16). With respect to the risk of hemorrhagic stroke, there was a positive interaction between the current use of oral contraceptives and smoking (odds ratio for women with both these factors, 3.64; 95 percent confidence interval, 0.95 to 13.87). CONCLUSIONS: Stroke is rare among women of childbearing age. Low-estrogen oral-contraceptive preparations do not appear to increase the risk of stroke.
Adolescent↗
Spontaneous foetal losses in women using different contraceptives around the time of conception.
Spontaneous losses between the 5th and 27th weeks of pregnancy were measured in a prospective study of 32 123 women whose contraceptive history around the time of conception was known. Diaphragm use prior to conception was associated with a significant reduction in second-trimester losses, after taking into account the effects of age, parity, race, marital status, alcohol use, and previous spontaneous or induced abortions. Women who used oral contraceptives and stopped them more than one month prior to their LMP experienced a deficit of first-trimester losses but conceptions occurring immediately after stopping the pill were followed by a small but nonsignificant increase in spontaneous abortions. After oral contraceptive failures there was an increase in first-trimester losses, but no change in the incidence of second-trimester ones. IUD failures were followed by a significant two-fold increase in the risk of both first and second-trimester losses: no differences were detected between the different brands.
Abortion, Spontaneous↗
Hormonal male contraception: progress and prospects for the 21st century.
During the second half of the 20th century, progress in developing novel, practical contraceptive methods for men has lagged significantly behind developments for women. Despite the lack of reliable, reversible methods, men throughout the world continue to be strongly involved in family planning but a greater involvement will require more attractive and reliable contraceptive options for men. The closest to fruition are hormonal methods the features of which are reviewed. Landmark WHO contraceptive efficacy studies have established that hormonally-induced azoospermia provides highly effective and reversible contraception for at least 12 months with minimal short-term side effects. Even among the small subgroup of men who remain oligozoospermic during hormonal suppression, good contraceptive efficacy is achieved. The present goals are to develop improved second generation hormonal regimens which provide more uniform azoospermia to obviate the need for monitoring of sperm output and to develop long-acting depot testosterone formulations used alone or with additional gonadotrophin suppressive agents such as progestins or GnRH antagonists. Significant obstacles to progress are the flight of industry from contraceptive R&D dur to the financial deterrent posed by the product liability crisis as well as the low priority accorded male reproductive health. Together those will determine whether the range of contraceptive options available to our children in the 21st century will improve, or whether the historically recent unbalanced increase in reliance on women for family planning will continue.
Animals↗
Practical problems which women encounter with available contraception in Australia.
Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.
Australia↗
Adolescent males' sexual behavior and contraceptive use: implications for male responsibility.
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Acquired Immunodeficiency Syndrome↗
Prospective multicentre study comparing levonorgestrel implants with a combined contraceptive pill: final results.
Norplant is a hormonal, long term method of contraception requiring the sub-dermal placement of six flexible capsules containing levonorgestrel in the inner aspect of the upper non-dominant arm. This open, prospective, multicentre, parallel group study, comparing the acceptability of Norplant and a combined pill, was originally designed to follow 700 subjects for five years, but was discontinued early. The main outcome criteria were duration of use and reason for discontinuation if appropriate. This final analysis, concerning the 364 subjects who used the implant and 307 subjects who used a gestodene/ethinyloestradiol combined pill, shows a statistically significantly higher (p<0.001) continuation rate amongst the implant users at 83.4 per cent compared to the pill users at 64.4 per cent at one year and this difference decreased only slightly by two years. The most common reasons for discontinuation by the end of the study were adverse events in both groups (menstrual and then mood changes in the implant group and mood changes and then headaches in the pill group). From the whole cohort the proportion which were 'very satisfied' were higher in the implant group (28.5 per cent compared to 14.6 per cent). This study confirms, in the UK, a high continuation rate for implant users similar to other countries as reported in the literature. If acceptability and continuation rates are similar in the none study setting, then a substantial number of women will seek removal of the implant and possible reinsertion five years after the time of initial high popularity (ie 1999). Doctors need to be prepared for this possible high level of activity.
Adolescent↗