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PubMed1976

Secondary amenorrhoea and oral contraceptives.

Eight-seven cases of secondary amenorrhoea of more than 6 months' duration developing after treatment with oral contraceptives (group I) were compared with 227 cases of secondary amenorrhoea not preceded by treatment with combined tablets (group II). The two groups were collected during the same period. The average age of the patients was 4 years higher in group I than in group II. Oligomenorrhoea and previously occurred in 30% of group I and in 46% of group II. Pronounced predisposing factors., such as psychogenic trauma and stress with or without considerable change in body weight, were encountered in 26% in group I and 56% in group II. The incidence of increased urinary output of 17-keto steroids, 17-ketogenic steroids and of hirsutism was slightly higher in group II. The percentage of eosinophilic cells in vaginal scrapings was low in 20% in group I as compared with 46% in group II. Spontaneous return of pituitary-ovarian function occurred in 40% in both groups. Patients recovering spontaneously in group I presented a maximum during the first few months, followed by a steady and fairly uniform decline. Spontaneous recovery in group II was more or less independent of time. It seems reasonable to believe that oral contraceptives did promote or contribute to the development of secondary amenorrhoea in about 50%, representing cases with various predisposing factors. A causal relation between oral contraceptives and secondary amenorrhoea was indicated in the remaining 50% because of perfectly normal ovarian function before treatment and absence of predisposing factors.

Adolescent↗
PubMedDate not supplied

The transdermal contraceptive patch: a new approach to hormonal contraception.

The transdermal contraceptive patch delivers ethinyl estradiol and norelgestromin (17-deacetylnorgestimate) at a rate over seven days that results in efficacy paralleling that achieved with oral contraceptives. Due to the pharmacokinetics of the system, adequate steroid levels are maintained for two days beyond the recommended duration of use of an individual patch, with resulting maintenance of efficacy. With perfect use, the failure rate is 0.70 pregnancies per 100 woman-years and for typical use, the rate is 0.88 pregnancies per 100 woman-years. Body weight above 90 kilograms (198 pounds) is associated with lower efficacy. Cycle control is similar to that achieved by oral contraceptives. With the exception of a transient increase in breast tenderness, the side effect profile is similar to that noted by oral contraceptive users. A major advantage of this method compared to oral contraceptives is a nearly 90% perfect adherence to the dosing schedule across all age groups. Partial or total detachment of the patch occurs at an overall rate of 3.8%. This rate is not affected by warm humid climates, vigorous exercise, or exposure to saunas or water baths.

Adhesiveness↗
PubMed2005

[Contraception in young adolescents].

The continuing increase in teenage pregnancies and abortions calls for more effective sex education on the one hand, including a detailed explication of the (perfectly normal) changes an adolescent body is undergoing, but we also need to understand the way teenagers actually do use contraceptives. Modern contraception for teenagers should not cause any side effects and its efficacy must not be linked to compliance. Gynaecologists must acquaint themselves with the laws covering the prescription of contraceptives to adolescents. Whether hormonal contraceptives for men are also suitable for teenage boys remains to be seen. Advising mentally or physically handicapped teen-agers or those with chronic diseases on their contraceptive options is particularly challenging. Adolescents are more prone to contract HPV infections and thus need to be screened, counselled and told about the association between HPV and cervical dysplasia.

Adolescent↗
PubMed2002

Contraceptive efficacy and patient acceptance of Lunelle.

PURPOSE: To review the efficacy, safety, and patient acceptance of the Lunelle monthly contraceptive injection and to raise awareness of this new contraceptive in the United States. DATA SOURCES: Worldwide scientific literature, reports of clinical trials, and manufacturers' product information and guidelines. CONCLUSIONS: Lunelle is a combined hormonal method with a safety/tolerability profile comparable to that of oral contraceptives (OC) and a high efficacy rate and provides a rapid return of fertility after discontinuation. Moreover, Lunelle was well accepted in a large clinical trial, with satisfaction levels similar to those of new-start OC users. IMPLICATIONS FOR PRACTICE: Oral contraceptives are the most popular hormonal birth control method in the United States; however, typical use is associated with higher failure rates than those observed with perfect use because of poor compliance. Poor compliance has been attributed in part to the need for daily administration. A new contraceptive method that does not require daily administration and is readily reversible may be suitable for many women, resulting in better overall efficacy.

Contraceptive Agents, Female↗
PubMed1969

Steps in the reproductive process susceptible to regulation.

During the past decade, family-planning programmes have been conducted on the assumption that developments in the field of contraception (e.g., hormonal contraceptives and intra-uterine devices) had reached a stage of considerable technical perfection. Enough information has now been accumulated, however, to indicate that this assumption was not fully justified; the high drop-out rates from these programmes observed under different conditions indicate that there is an urgent need for further improvements of the existing methods and for the development of new methods based on different approaches. A prerequisite for the development of such methods is a greatly improved knowledge of the physiological factors influencing the various steps of the reproductive processes in the human species.In an attempt to focus attention on the various steps which are susceptible to controlled interference, a brief review is given of some of the present concepts of the regulation of spermiogenesis, ovulation and the menstrual cycle, sperm capacitation, fertilization, tubal passage, zygote and blastocyst formation, implantation and early embryonic development. It is concluded that the reproductive processes are indeed subject to intricate biochemical and hormonal regulatory mechanisms and that the different phases of these processes do offer a variety of possibilities for hormonal, pharmacological and perhaps also immunological interference.

Adrenal Cortex Hormones↗
PubMedDate not supplied

The cervical cap: an alternative contraceptive.

The cervical cap is a convenient, inexpensive, nonhormonal and non-invasive contraceptive method. This method has potential for better effectiveness if custom-fit caps are manufactured. As more health care providers become knowledgeable in the use of the cap, more women will become aware of this contraceptive method as an alternative to oral contraceptives and intrauterine devices. Research is needed to document the most accurate method of cervical cap fitting and the effectiveness rate of the cervical cap. Nurse practitioners who counsel patients and fit them for caps are in the perfect position to start doing this research.

Contraceptive Devices, Female↗
PubMed2001

Using cognitive theory to improve nurse practitioners' anticipatory guidance with contraceptive pill users.

Community health nurse practitioners are often the major contraceptive counselors who may use anticipatory guidance to help clients' use behaviors. Because pregnancy rates during typical use are much higher than during "perfect" use, more effective anticipatory guidance could help improve use behaviors. Principles of cognitive theory were used to explore the implications of specific words and approaches associated with discussing young adults' contraceptive use. Qualitative results are reported here, and potential implications are made for nurse practitioners' anticipatory guidance related to contraceptive use.

Adult↗
PubMedDate not supplied

Contraceptive use among U.S. women having abortions in 2000-2001.

CONTEXT: Knowing the extent to which contraceptive nonuse, incorrect or inconsistent use, and method failure account for unintended pregnancies ending in abortion, as well as reasons for nonuse and imperfect use, can help policymakers and family planning providers support effective contraceptive use. METHODS: Contraceptive use patterns among a nationally representative sample of 10,683 women receiving abortion services in 2000-2001 were examined, as well as reasons for nonuse, problems with the most frequently used methods and the impact emergency contraceptive pills have had on abortion rates. RESULTS: Forty-six percent of women had not used a contraceptive method in the month they conceived, mainly because of perceived low risk of pregnancy and concerns about contraception (cited by 33% and 32% of nonusers respectively). The male condom was the most commonly reported method among all women (28%), followed by the pill (14%). Inconsistent method use was the main cause of pregnancy for 49% of condom users and 76% of pill users; 42% of condom users cited condom breakage or slippage as a reason for pregnancy. Substantial proportions of pill and condom users indicated perfect method use (13-14%). As many as 51,000 abortions were averted by use of emergency contraceptive pills in 2000. CONCLUSIONS: Women and men need accurate information about fertility cycles and about the risk of pregnancy when a contraceptive is not used or is used imperfectly. Increased use of emergency contraceptive pills could further reduce levels of unintended pregnancy and abortion.

Abortion, Induced↗
PubMed1982

[Portal and superior mesenteric venous thrombosis secondary to oral contraceptive treatment. Two cases (author's transl)].

Two new cases of superior mesenteric, portal and pulmonary venous thrombosis enable the authors to stress the close link between this pathology and the ingestion of oral contraceptives. The resultant vessel wall changes and laboratory changes are described. Whilst complete normalisation at the end of treatment is confirmed, preventive treatment will soon be possible by virtue of the development of new natural substances already perfected in the United States and the Scandinavian countries and recently marketed in our own country.

Adult↗
PubMed1994

Contraceptive efficacy and acceptability of the female condom.

OBJECTIVES: The purpose of the study was to determine the contraceptive efficacy of the female condom and to provide data about the device to the US Food and Drug Administration. METHODS: The clinical trial was conducted at six US sites and three sites in Latin America. Eligible subjects were in mutually monogamous relationships and agreed to use the female condom as their only means of contraception for 6 months. RESULTS: A total of 328 subjects contributed to the analysis of contraceptive efficacy. Twenty-two US subjects and 17 Latin American subjects became pregnant, yielding 6-month gross cumulative accidental pregnancy rates of 12.4 and 22.2, respectively. During perfect (consistent and correct) use of the method, the 6-month accidental pregnancy rates were 2.6 and 9.5 for the US and Latin American centers, respectively. There were no serious adverse events related to the use of the method. CONCLUSIONS: The female condom provides contraceptive efficacy in the same range as other barrier methods, particularly when used consistently and correctly, and has the added advantage of helping protect against sexually transmitted diseases.

Adult↗
PubMed2002

[Treatment of acne by isotretinoin (general course)].

Acne is a chronic disease which evolves under periodic eruptions. Resolution occurs around the late teens. Conventional treatment clears the lesions, but treatment by isotretinoin alone can achieve long remissions indeed definitive clearing. Indications are nodulo-cystic acne and resistant acne to a conventional treatment of at least 3 months duration. This drug is prescribed in cures, a cure is the period during which the patient receives a continuous treatment. The daily dose is computed according to the patient's weight and varies between 0.5 and 1 mg/kg. To prevent relapses, it is recommended to cumulate a dose between 100 and 150 mg/kg. No other topical or systemic treatment is needed. Side effects exist, among which teratogenicity is the most severe. Very strict contraception is necessary for women of child-bearing age. The most important mucocutaneous side effect is dryness and has to be counteracted by emollients. It is recommended that the drug be prescribed by doctors having a fair experience of oral retinoids and a perfect understanding of the teratogenic risk of the drug.

Abnormalities, Drug-Induced↗
PubMed2005

Preference for and satisfaction of Canadian women with the transdermal contraceptive patch versus previous contraceptive method: an open-label, multicentre study.

OBJECTIVE: To document Canadian women's experience with the transdermal contraceptive patch, a method delivering 150 microg norelgestromin and 20 microg ethinyl estradiol daily. METHODS: We conducted an open-label, multicentre, descriptive cohort study of the contraceptive patch over 9 cycles in 392 women requiring contraception. A single treatment cycle consisted of 3 consecutive 7-day patch applications followed by 1 patch-free week. At the final visit, overall satisfaction and preference for the patch was rated and compared with the previously used contraceptive method. RESULTS: At baseline, 80.9% of participants were either very satisfied or somewhat satisfied with their previous contraceptive method, 89% having used oral contraceptives. At final observation, 60.6% of participants preferred the patch, 9.3% had no preference; and 30% preferred their previous method (n = 376). A total of 279 participants (71.2%) completed 9 cycles of patch use. Of these, 91% were satisfied with the patch and 74.9% preferred the patch to their previous contraceptive (43% strongly preferred and 31.9% preferred); 9% had no preference; and 16.1% preferred their previous method. Of those who preferred the patch, 82.7% preferred it because of its convenience or simplicity. Across all cycles, 88% of participants recorded perfect compliance. The most common adverse event was application site reactions (most of which were mild), experienced by 49% of participants: 33.7%, 16.5%, and 14.7% at cycles 1, 4, and 9, respectively. CONCLUSION: Both preference for and satisfaction with the transdermal contraceptive patch were high. Most participants.

Administration, Cutaneous↗
PubMed2004

Women's bodies, doctors' dynamics.

Medicine treats men's and women's reproductive organs and functions markedly differently. Interventions affecting male functioning are regarded as very serious and are seldom undertaken except to treat significant pathology. Interventions affecting perfectly normal female functioning, such as treatment for menstrual cycle mood changes, menopause, episiotomy, cesarean and other assisted delivery, hormonal contraception, and even hysterectomy, are rampant. These interventions can be attributed to men's unconscious (and conscious) curiosity, jealousy, hostility, and helplessness about female reproduction, coupled with the fact that men have dominated the field of medicine for most of its history. This article describes these interventions and the rationalizations for them, and questions their utility and meaning in the light of current knowledge.

Contraception↗
PubMed1993

Family planning: cultural and religious perspectives.

The world population explosion has caused political leaders to look upon national and regional birth control projects as vital. Support for regulation of individual fertility has been evident in all cultures, and at all times, even in those societies in which social and religious rules have favoured the abundant production of children. As the secularization of Western society and scientific enquiry gained momentum during the modern period, knowledge of reproduction increased and was applied to control human population growth. The various methods of contraception and their development through the years from the ancient ideas to the modern era are presented. Each approach to fertility control has its advantages and disadvantages. No one method is perfect for everyone, for every clinical setting, and in every culture. Higher levels of fertility have been associated with 'traditional', religious prohibitions on some forms of birth control, 'traditional' values about the importance of children and the priority of family, and 'traditional' family and gender roles reinforced by religion. The attitude of the main religious groups to contraceptive practice is discussed.

Contraception↗
PubMed1996

[Myocardial infarct with oral contraceptives: simultaneous thrombotic occlusion of the anterior interventricular ramus and the circumflex ramus].

A 28-year-old, previously healthy mother of one child, with cigarette smoking and oral contraceptive medication as only risk factors suffered an acute anterior myocardial infarction without prior anginal complaints. Angiographically there were thrombotic occlusions of the LAD after the first septal branch and also of the distal left circumflex coronary artery. Six days after catheter recanalisation of the LAD and i.e. infusion of urokinase, there were small residual thrombi in the otherwise perfectly normal LAD and in a diagonal branch whereas the circumflex coronary artery was completely normal. The left ventricle showed anteroseptal (but not inferior) akinesis. The case report supports the hypothesis that myocardial infarctions under oral contraceptive medication are a separate disease entity unrelated to coronary atherosclerosis and may be the consequence of a "coagulation accident".

Adult↗