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PubMed1989

Pregnancies in reliable pill takers.

This study is an extension of a previous study on oral contraceptive pill method failure in reliable pill takers. It documents 137 cases which presented during the 3 year period from December 1985 to December 1988. The most important new finding is that smoking is a significant risk factor in failure on the combined pill (67% were smokers, n = 118), but not on the progestagen-only pill, although the numbers in the latter group were small (n = 19). Diarrhoea and/or vomiting (46%) and drug interactions (33%) are confirmed as important predisposing factors. Systemic illness and/or severe psychological stress may also affect pill utilisation and such factors were found in 47%. Menstrual disturbances were found in 32% of women on the combined pill and 68% of these were smokers. Multiple factors were present in most cases (79%). Repeat failures occurred in 25%.

Adolescent↗
PubMed1983

A comparison of the efficacy of two vaginal creams for vulvovaginal candidiasis, and correlations with the presence of Candida species in the perianal area and oral contraceptive use.

In a double-blind clinical study, 93 patients with vulvovaginal candidiasis were randomly assigned to treatment with either clotrimazole (1%) or miconazole (2%) vaginal cream for seven days. The treatments were comparable in reducing the severity of presenting signs and symptoms. At one and four weeks posttherapy, negative vaginal cultures were found in 84.4% and 75.0%, respectively, of the clotrimazole-treated patients and in 85.4% and 74.5%, respectively, of the miconazole-treated patients. The incidences of recurrence/reinfection and treatment failures were comparable in the two groups. Treatment failures and recurrences/reinfections were not correlated with positive perianal cultures for Candida species. Patients using oral contraceptives had a higher incidence of positive vaginal cultures at four weeks posttherapy than did patients not using oral contraceptives or using other methods.

Adult↗
PubMed1984

Oral contraception for the adolescent.

Sexual activity among unmarried women aged 15-19 living in metropolitan areas rose 66% in the 1970s. Additionally, teenage pregnancies average 1.2 million yearly. However, based largely upon a 25% increase in contraceptive use, the pregnancy rate among teenagers declined 15% between 1973 and 1978. The data on the use of various contraceptive methods by women aged 15-19 show the Pill to be the first choice (1,539,000). Oral contraceptives are safest for young women, with rare risks of serious cardiovascular complications and no deaths reported from cardiovascular disease for women under 18. In contrast, the mortality risk associated with childbirth for this age group is 11.1 deaths per 100,000 live births. Noncontraceptive health benefits associated with oral contraceptive use, such as a 50% decrease in the risk of developing pelvic inflammatory disease, resulting in a protective effect on future fertility, is an excellent rationale for prescribing the Pill for young women who are sexually active. The pill of choice should be one with low doses of both estrogen and progestin yet doses high enough to minimize break-through bleeding, for such bleeding is the most frequent cause of discontinuation. Adolescents require careful screening for contraindications to Pill use prior to initial prescription plus frequent follow-up and monitoring so as to minimize side effects and maximize compliance and continuation of use.

Adolescent↗
PubMed1995

[Use of the pill by adolescents for contraception or as therapy].

OBJECTIVE: To describe frequency of oral contraceptive (OAC) use, indications for OAC use and influence of calender age, gynaecological age (age minus age at menarche) and level of education on OAC use among ninth grade secondary school girls. SETTING: Secondary schools in Amstelland-de Meerlanden, a combined urban and rural region to the south of Amsterdam. METHOD: By questionnaire and individual interview on menstrual cycle pattern and OAC use, school girls were asked about duration and reasons for OAC use and what preparation they used. RESULTS: The response to the questionnaire was 92%, that to the interview 83%. Of the 2248 responders 248 (11%; mean age 15.3 years (SD: 0.6)) used OAC: 74% used low dose 'sub 50' preparations, 3% pills with 50 micrograms oestrogen, 3% 3-phase preparations and 17% pills with antiandrogens. Of girls aged 14, 15 and 16 years 4%, 12% and 28%, respectively, used OAC. Of the 15-year-olds 36% mentioned contraception as most important reason, 20% menstrual cycle irregularity, 28% dysmenorrhoea, 12% acne and 5% other reasons. With multiple logistic regression analysis age, gynaecological age and level of education were independent variables for OAC use in general and for OAC use for contraception or dysmenorrhoea, but less so for OAC use for menstrual cycle irregularity or acne. CONCLUSION: During adolescence low dose OACs are frequently used. Of adolescent OAC users 36% mentioned contraception as most important reason. OAC use in the Netherlands among girls aged 15 and 16 years doubled in comparison with 1982. Gynaecological age and calender age (determinants of biological maturation), and level of education (a determinant of life style) were associated with OAC use.

Acne Vulgaris↗
PubMed1981

Acceptability of the contraceptive vaginal ring by rural and urban population in two Latin American countries.

A study of the field acceptability of the Contraceptive Vaginal Ring (CVR) was carried out in rural, small town and urban slum clinics in four locations, two in Brazil and two in the Dominican Republic (D.R.) The CVR was offered as a new method in the clinics and described as similar to the pill but placed in the vagina for three weeks each month with a one-week rest interval. Follow-up surveys were carried out in the four locations at the end of the experimental period. Three, eight, nine and 12.5% of the total acceptors in each of the 4 locations chose the CVR. The acceptance rate fell after the first five months but recovered during the second year. The acceptance rate was much higher in three rual clinics where the nurses themselves used the ring. The follow-up surveys showed that the fact that the ring is placed and kept in the vagina without removal for a prolonged period was the most important attribute of the method and played a large role in women's reactions to it. Anticipated use-related problems were the most prominent reason given by pill users for not choosing the ring, however ease of use was named as the "most killed" characteristic by 55% of ring users. Women tended to remove the ring for intercours and washed it frequently, often with detergents, thus illustrating their concern with "cleanliness" of an object kept within a body cavity for long periods of time.

Brazil↗
PubMed1981

Factors associated with family planning acceptance in Bangkok metropolis health clinic areas (MHCs).

To study contraceptive use in Bangkok, 6,809 eligible women were interviewed in a community survey of 5 Metropolis areas. 34.7% were current users of interval contraception and the pill was the most common method. 29.9% were not currently in need of family planning. 18.3% of women were not using contraception, but only 6.2% were in need of family planning (FP) and not currently practising contraception. Non-acceptors who were in need of FP, had a lower educational level; 13.4% did not know about contraception but 52.4% previously used contraception. The most common reason for not currently practising FP was fears about contraceptive safety (37.5%). The prevalence of pregnancy in the community was 10.4%. The fact that only 6.2% of women were not practising FP and were in need of contraception suggests that the services in Bangkok are adequate to meet the needs of most women. However, the subgroup of non-acceptors in need of FP who were from a low socio-economic group require special motivation and services. 1,835 women attending Metropolis Health Centres in the same areas were interviewed to determine their choice of contraception; 57.4% chose the pill.

Contraception Behavior↗
PubMed1983

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↗
PubMed1987

Contraception: an overview.

In this century, paramount progress has been made in many areas of medicine, not least in the field of contraception, with landmarks such as the introduction of intrauterine contraceptive devices (IUDs), hormonal contraceptives (OCs), and laparoscopic sterilization. The general optimism of the 1960s about overcoming the problems of global overpopulation with these new tools has subsequently been replaced by growing concern about the risks of contraception in general and of OCs especially. It was not before the 1980s that the benefit-risk balance of hormonal contraception turned out to be much more favorable than was formerly suspected. The wide variation from country to country in the prevalence of contraceptive methods has economic, political, religious, sociological, educational, and legal rather than medical reasons. Former misjudgments have led to a ban on valuable tools such as the sequential regimen or the use of 17-acetoxyprogestogen analogues as components in OCs, or to a ban on the licensing of depot progestogens in some countries but not in others. The recent decision of U.S. firms to cease production and sale of IUDs for legal reasons is unique and hopefully will not be imitated elsewhere. Just after the introduction of oral contraception, tremendous inventive dynamics led to the discovery of several new contraceptive principles. Most of these have reached the stage of clinical application and are being used satisfactorily, at least in some parts of the world. Later contraceptive concepts are still in the stage of experimentation and no breakthrough appears to be directly ahead. If contraception means more than just meeting individual wants--if it is also to be an instrument for handling the increasing problems of overpopulation--then much more must be done to deepen our knowledge of reproductive physiology, to popularize efficient means of contraception, and to make them available to everyone. Otherwise, all efforts to improve health standards throughout the world according to the "WHO Global Strategy for Health for All by the Year 2000" will be in vain.

Contraception↗
PubMed1997

Contraceptive outcomes among adolescents prescribed Norplant implants versus oral contraceptives after one year of use.

OBJECTIVE: Our goal was to evaluate both the continuation and pregnancy rates and the side effects experienced during the first year of use by adolescents who selected Norplant implants as compared with those who chose oral contraceptives for contraception. Furthermore, side effects experienced at 6 versus 12 months among Norplant implant users were compared to determine whether they diminished with continued use of this method. STUDY DESIGN: We conducted a case-control study of 56 adolescents < or = 18 years old who selected implants as compared with 56 age-matched controls who chose oral contraceptive pills during the same time period. RESULTS: Only 34% of patients prescribed oral contraceptives as compared with 91% of Norplant implant patients were still using their chosen method 1 year later. As a result 25% of oral contraceptive users became pregnant within 12 months as compared with none who selected Norplant implants. Side effects were reported by > 80% of patients in both groups, with menstrual irregularities reported more often by Norplant implant users than by oral contraceptive users (73% vs 5%, p = 0.01). Furthermore, Norplant implant users gained more weight than oral contraceptive users (8.7 vs 4.2 pounds) and were twice as likely to have an abnormal Papanicolaou smear. Finally, little diminution in side effects was observed during the second 6 months of Norplant implant use. CONCLUSIONS: These data confirm that Norplant implants provide better protection against unintended pregnancy in an adolescent population but may be associated with more side effects. Clinicians should be aware of these findings so they can adequately counsel young patients about these two methods of contraception.

Adolescent↗
PubMed1998

The epidemiology of oral contraceptive use: a critical review of the studies on oral contraceptives and the health of young women.

Recent observational studies show a slightly increased risk of venous thromboembolism among users of newer combined oral contraceptives with odds ratios between 0.8 and 2.3 when compared with users of older oral contraceptives. The controversy regarding the newer oral contraceptives is reviewed by analyzing the recent studies with epidemiologic methods. Key studies on venous thromboembolism may be subject to bias related to prescribing criteria, diagnostics, hospital referral, cohort effects, and residual confounding, resulting in an overestimate of the risk of venous thromboembolism associated with the newer oral contraceptives. The studies on stroke showed no difference between newer and older oral contraceptives, and studies on myocardial infarction show that newer oral contraceptives carry no risk of this event. Newer-generation oral contraceptives are unlikely to constitute a significant hazard to the user population with regard to venous thromboembolism. The results for other disease entities also need to be taken into account when the results on venous thromboembolism are assessed on a population basis.

Adolescent↗
PubMed1998

A scenario study of oral contraceptive use in Japan. Toward fewer unintended pregnancies.

A scenario study was conducted to assess the extent to which the unintended pregnancy rate in Japan, where oral contraceptives (OC) have not been legalized for family planning purposes and couples rely mainly on condoms, might change if more women were to use OC. Because current rates of unintended pregnancy and abortion in Japan are not known, data provided by the 1994 Japanese National Survey on Family Planning were used to construct scenarios for national contraceptive use. Annual failure rates of contraceptive methods and nonuse were applied to the contraceptive use scenarios, to obtain estimates of the annual number of contraceptive failure-related pregnancies. Subsequently, contraceptive practice situations assuming higher OC use rates were defined, and the associated change in the number of contraceptive failure-related pregnancies was estimated for each situation. It emerged that OC use rates of 15% decreased the expected number of unintended pregnancies by 13%-17%, whereas use rates of 25% resulted in decreases of 22%-29% and use rates of 50% in decreases of 45%-58%. The findings were reasonably robust to variation in the assumptions that were made. In conclusion, each theoretical percentage increase in the OC use rate in Japan was found to lead to a roughly equivalent percentage decrease in the number of unintended pregnancies.

Adolescent↗
PubMed1996

Prospective study of exogenous hormones and risk of pulmonary embolism in women.

BACKGROUND: Current use of oral contraceptives (OCs) is a well-recognised risk factor for venous thrombosis and consequent pulmonary embolism (PE). Little is known about residual effects of past OC use. Furthermore, few epidemiological studies have assessed the relation between postmenopausal use of hormones and thrombotic disease. METHODS: In this prospective study information was obtained through questionnaires sent every 2 years (1976-92) to 1125,93 women aged 30-55 in 1976. We excluded women with previously diagnosed cardiovascular disease or cancer in 1976 and at the beginning of each subsequent 2-year follow-up period. FINDINGS: From self-reports and medical records, we documented 123 cases of primary PE (no identified antecedent cancer, trauma, surgery, or immobilisation). Current users of postmenopausal hormones had an increased risk of primary PE (relative risk adjusted for multiple risk factors 2.1 [95% CI 1.2-3.8]). However, past use showed no relation to PE (1.3 [0.7-2.4]). In current users of OCs the risk of primary PE was about twice that in non-users (2.2 [0.8-5.9]), but this finding was based on only five cases who were current OC users. Users of OCs in the past had no increase in risk of PE (0.8 [0.5-1.2]). These relations were consistent irrespective of cigarette-smoking status. INTERPRETATION: Primary PE was uncommon in this cohort. The risk was increased by current though not past use of postmenopausal hormones or OCs.

Adult↗