A study of contraceptive choice and use in Bangkok Metropolis Health Clinics.
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Adult↗
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The Prentif contraceptive cervical cap: acceptability aspects and their implications for future cap design.
Patients in a private gynecological practice were offered the Prentif contraceptive cervical cap. The first 413 acceptors were sent a questionnaire covering in detail many of the aspects of their experience. The 371 responses contained a wealth of information concerned with safety, effectiveness and acceptability. Safety and effectiveness are dealt with in the companion article preceding, while the less serious risk factors that reduce the acceptability of the Prentif cap are presented and discussed herein. In order of descending frequency, these factors include: odor; difficulty removing; discomfort to partner; difficulty inserting; dislike of spermicide; discomfort to self; urinary discomforts; vaginal infections; vaginal discharge; and vaginal itching. The most attractive features of the cap, as compared with the diaphragm, were: increased convenience; greater safety; less interference with spontaneity; increased frequency of intercourse; and increased libido. Despite multiple problems with Prentif caps, 67.4% of the cap recipients were still using their caps after one year. However, this was among a select group of highly motivated women of above-average intelligence. The causes of cap acceptability problems are discussed along with probable future improvements in cap design that may solve them.
Adult↗
Four years of a comparative study with Nova T and Copper T 200 IUDS.
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Adult↗
Presence of ethynyl-estradiol (EE-2) in blood and endometrium after interrupting steroidal contraception for three months.
Serial studies were conducted in five women under norgestrel + EE-2 after interrupting 11-34 months of regular use of the medication. A venous blood and an endometrial sample were simultaneously obtained from each subject between the 22nd and 25th day of the pseudocycle (last month of contraception) and on the same days of the following three cycles under no treatment for the measurement of EE-2 content. Values during and after the first month of no medication were: plasma = 85 +/- 6 versus 218 +/- 36 (pg/ml; P less than 0.001) and endometrium = 93 +/- 10 versus 29 +/- 7 (ng/g wet tissue; P less than 0.001). A decrement of circulating EE-2 from 346 pg/ml in the first month with no medication to 14 pg/ml in the third month off the treatment was observed. The EE-2 endometrial uptake of 93 +/- 10 (last month of steroidal ingestion) decreased to 29 +/- 7, 7 +/- 2 and 4 +/- 0.9 ng/g wet tissue in the following three months of no treatment. In 3/15 instances after interrupting contraception, circulating EE-2 was below the detection limit of the assay, while endometrial EE-2 uptake was in the range of 3-19 ng/g wet tissue. These data confirm our apparent controversial report that EE-2 plasma levels increased during the first month after interrupting medication and support the presence of the exogenous estrogen in plasma and endometrium after interrupting the steroidal contraceptive for three months.
Adult↗
Sexual and reproductive life events in relation to duration of oral contraceptive use.
In order to disclose differences between users and non-users of oral contraceptives (OC), 620 women aged 15-54 were invited to participate in an in depth interview about sexual, contraceptive, and reproductive life events. Of the 585 women who participated, 459 were consecutive gynecological in- or outpatients, and 126 were selected from visitors in general practice. Data was analysed by multivariate test statistics. After correction for present age and social class, the duration of use of OC (DOC) among women 15-34 years of age correlated negatively to age at menarche and coital debut and positively to number of sexual partners, oral-genital sexual practice, and number of pelvic inflammatory diseases. Among women over 35, DOC was positively associated only to cigarette smoking. No correlation was found to coital frequency (whether earlier, present or during pregnancy or menstruation), number of births and abortions, or to social classification. In epidemiological research on benefits and risks of oral contraceptives, confounding influence of one or more variables is of crucial importance. The present findings point at sexual and life-style habits as potential confounders in the study of OC and associated diseases.
Adolescent↗
Acceptability of an experimental intracervical device: results of a study controlling for selection bias.
We analyzed baseline and 12-month follow-up interview data from 98 women who had volunteered to use an experimental intracervical device (ICD) and from 155 women who had been randomly assigned to two control groups, the levonorgestrel-releasing intrauterine device (LNG-IUD; N = 86) and the copper Nova-T IUD (N = 69). All participants were clinic patients in Helsinki, Finland. Initial analysis of 12-month discontinuation data indicated that a significantly higher percent of ICD users (22.4) discontinued their device than did either LNG-IUD (7.0) or Nova-T (8.7) users. However, we were no longer able to detect significant differences in discontinuation after controlling for baseline variables that assessed predisposition to be dissatisfied with contraception in general. Adjusted probabilities of discontinuing the ICD, LNG-IUD, and Nova-T were 11.8%, 6.2% and 7.9%, respectively. These data indicate that the ICD is likely to be acceptable to Helsinki clinic patients; moreover, they suggest a definite place for hormonal intrauterine devices in the contraceptive armamentarium. Most importantly, the methodology used here can be generalized to acceptability studies of other contraceptive devices and drugs undergoing Phase I and early Phase II clinical trials (in situations where randomization may not be feasible) in order to identify and control for the bias introduced by nonrandom assignment procedures.
Adolescent↗
Contraception after heart surgery.
This study represents the different methods of contraception used by women having cardiac surgery at Ain Shams University Hospital. The study comprised of 250 women having had mitral commissurotomy, 77 women having had valve replacement including one case of triple valve repair and 3 women having had cardiac surgery for congenital heart disease. An IUCD was used by 170 women (51.5%), vaginal tablets by 4 women (1.2%), oral contraceptive pills by 7 women (2.1%), "safe period" by 7 women (2.1%), tubal ligation was performed in 10 women (3%). The husbands of 33 women (10%) used condoms, and 99 women (30%) did not use contraceptive methods. The IUCD was tolerable and was associated with bleeding in 60 women (35.2%) and leucorrhoea in 55 (32.3%). The IUCD was removed from only one woman due to severe bleeding. Three pregnancies occurred with condom users in two women who had had mitral commissurotomy and one having had valve replacement. There was no case of bacterial endocarditis in the study group.
Abortion, Spontaneous↗
Once-a-month injectable contraceptives: efficacy and reasons for discontinuation.
Reports of the phase III clinical trials on four combined progestogen-estrogen once-a-month injectable contraceptives, Deladroxate, Cyclofem, Mesigyna and Chinese Injectable No. 1, are reviewed focussing on efficacy and reasons for discontinuation. Deladroxate, currently used in many Latin American countries has proved to be highly effective and well accepted. However, this combination was withdrawn by the original manufacturer because the progestogen component of this drug induced a high number of breast cancers in dogs and very curious pituitary hyperplasia in rats. Cyclofem and Mesigyna were found to be highly effective and highly acceptable drugs. Side-effects were minimal and were of minor importance. The Chinese Injectable No. 1 had unacceptably high failure rates with a monthly injection schedule. After doubling the dose in the first month of use, the efficacy was satisfactory. It was found that all monthly injectable contraceptives provided better cycle control than the every 3 months depot-medroxyprogesterone acetate, although abnormal bleeding was still the main drug-related complaint and reason for discontinuation. Missed appointment is another reason for discontinuation which might reflect the problem of frequent injection schedule, thus indicating the need for proper selection of the users and good counselling.
17 alpha-Hydroxyprogesterone Caproate↗
A comparative study of two estrogen dosages in combined oral contraceptives among Sudanese women.
A prospective study of two combined oral contraceptives was conducted in the Sudan. No pregnancies occurred. Overall incidence of side effects was low. Headache was most frequently reported. Elevations were observed for weight, systolic and diastolic blood pressures, and SGOT and SGPT values while a decrease was seen for hemoglobin levels. Menstrual irregularities were not a problem for the users. Total 6-month use discontinuation rates were low for both pill groups.
Contraceptives, Oral↗
Factors related to autonomy and discontinuation of use of natural family planning for women in Liberia and Zambia.
From 1983 to 1988, natural family planning programs were conducted in Liberia and Zambia. In Liberia 1055 and in Zambia 2709 women used natural family planning to avoid pregnancy. These users could become pregnant, discontinue use of the method, or become autonomous users. Women who changed intention did not stop use of natural family planning and were not treated as discontinuations. In a multivariate analysis, client's age, breastfeeding status, employment, urban/rural residence, time of registration in the program, and visit intensity were significantly associated with the outcomes. The most consistent association was that women who entered the programs in the later time periods were more likely to become autonomous users and less likely to discontinue use of the method or to experience an accidental pregnancy.
Adolescent↗
Norplant consensus statement and background review.
This review has highlighted the attributes of a very important new method of contraception. The signatories to this document agree that, with the provision of appropriate information and instruction for the user, Norplant is a good contraceptive choice to be made available worldwide in family planning programs that have the resources for appropriate training and counseling. The signatories to this document are acting in their own personal capacity and not as representatives of any particular organization.
Contraceptive Agents, Female↗
Side effects and discontinuation of oral contraceptive use in southern Brazil.
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Adolescent↗
Patterns of contraceptive use among urban women in Taiwan.
Patterns of contraceptive use among married urban women in Taiwan were investigated. A convenience sample of 150 women attending health clinics for reasons other than contraceptive care were interviewed about their contraceptive use. The most prevalent contraceptive method used by these women was the intrauterine device, followed by the condom and birth-control pills. Participants had used only one or two contraceptive methods throughout their contraceptive careers, and many stated they were satisfied with their current method. Many participants were able to name the methods of birth control promoted by the Taiwan family-planning promotion program. Knowledge of alternative methods did not significantly relate to current method in use or to desire to change methods.
Adult↗
Oral contraceptive use and fibrocystic breast disease among pre- and postmenopausal women.
The association between use of oral contraceptives and fibrocystic breast disease was assessed among women aged 20-74 years in a hospital-based case-control study conducted between November 1979 and November 1981 in Connecticut. The study groups comprised 633 women with biopsy-proven fibrocystic breast disease and 1,062 controls who had been admitted, as inpatients or outpatients, to general surgical services. For the premenopausal women, there was no evidence that long-term use of oral contraceptives was associated with a decreased frequency of fibrocystic breast disease among either current or past users. For the postmenopausal women, previous oral contraceptive exposure was associated with an increased occurrence of cystic disease. These findings contradict previous investigations reporting a negative association between oral contraceptive use and the development of fibrocystic breast disease.
Adult↗
Estrogen replacement therapy and the risk of breast cancer: results from the case-control surveillance study.
To examine the relation of noncontraceptive estrogen use to the risk of breast cancer among postmenopausal women, the authors conducted a case-control study: 1,686 cases were compared with 2,077 hospital control subjects, of whom 1,120 had non-gynecologic cancers and 957 had nonmalignant (also non-gynecologic) conditions. Data were obtained from 1980 to 1986, by interview of subjects in hospitals in the United States and Canada. The relative risk estimate for any use of replacement estrogens unopposed by progestogens was 1.2 (95% confidence interval (Cl) 1.0-1.4), after adjustment for age and type of menopause; when all known risk factors for breast cancer were taken into account in a multivariate analysis, the estimate was similar. For use of at least 15 years duration, the estimate was 0.9 (95% Cl 0.5-1.9). Most of the unopposed use was of conjugated estrogens: overall, the relative risk (95% Cl) was 1.3 (1.0-1.6); for durations of 15 or more years, it was 0.9 (0.4-1.9); for use of 5 years followed by a latent interval of 15 or more years, it was 1.3 (0.7-2.4); and for current use it was 1.1 (0.7-1.6). There was no evidence of increased breast cancer risk when the conjugated estrogen users were divided according to dose. There was little use of estrogens opposed by progestogens; the relative risk estimate was 1.7 (95% Cl 0.9-3.3). The results of this large study provide no evidence that the use of unopposed conjugated estrogens increases the risk of breast cancer, even after long durations of use or long latent intervals, but the possibility of a modest increase (less than a doubling) could not be excluded. There were insufficient data to evaluate the effects of nonconjugated estrogens and of combined estrogen and progestogen therapy.
Adult↗
Breast cancer risk and oral contraceptive use: results from a large case-control study.
The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.
Adult↗
The impact of family planning service provision on contraceptive-use dynamics in Morocco.
This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.
Adolescent↗
Teenagers' perceptions of unplanned adolescent pregnancies and oral contraceptive use.
Adolescent women who are sexually active often do not use contraceptives consistently and correctly. Adolescents are sexually active for an average of 15 months before initiating regular contraceptive use and the majority of young women who initiate use discontinue within the first year after initiation. This study enrolled 50 young women who initiated oral contraceptive use and was designed to provide more understanding of their perceptions about the possibility of an unplanned pregnancy and about contraceptive use. They were again contacted 6 weeks after initiation of oral contraceptives to assess continuation. Findings revealed that 90% of the subjects were sexually active at the time of the first visit; the mean period of sexual activity was 15 months. Only 30% had used a nonprescription birth control method during this period. While perceiving themselves to be highly susceptible to pregnancy, many young women continue to have psychosocial barriers to contraceptive use. Follow-up contact revealed more than 10% of the subjects were not using oral contraceptives.
Adolescent↗