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At least 613 records · Page 34Linked to original sources
PubMed1999

Endometriosis in adolescents. Incidence, diagnosis and treatment.

OBJECTIVE: To review the incidence and diagnosis of endometriosis in adolescents and to evaluate the surgical and medical treatment options for this special population. STUDY DESIGN: Literature research. RESULTS: Endometriosis is the most common cause of chronic pelvic pain in adolescents, affecting up to 70% of girls with chronic pelvic pain unresponsive to medical management. There may be a natural progression of endometriosis from atypical lesions in adolescents to classic lesions in adults. CONCLUSION: Endometriosis should be strongly suspected in adolescent girls with chronic pelvic pain unresponsive to oral contraceptives and nonsteroidal antiinflammatory drugs. Initial management of endometriosis involves surgical resection or destruction at the time of diagnosis followed by medical management with continuous oral contraceptives. Gonadotropin-releasing hormone agonists should be considered for adolescents over 16 years of age who have completed pubertal maturation.

Adolescent↗
PubMed1985

The effects of a combination of cigarette smoking and oral contraception on coagulation and fibrinolysis in human females.

Oral contraception as well as cigarette smoking influence haemostasis. The simultaneous effect of both on blood coagulation and fibrinolysis was studied in nine female smokers. While continuing oral contraception after a 4-week abstinence from smoking the concentration of fibrinogen, antithrombin III and alpha 1-Antitrypsin decreased (P less than 0.01 or P less than 0.04) and of plasminogen increased (P less than 0.03). The other coagulation parameters remained unchanged. Although all determinations of these parameters were in the normal range, the observed trends were statistically significant. The concentrations of the fibrinopeptide A and B 15-42 did not differ. It is concluded that the observed alteration is caused by cessation from cigarette smoking.

Adult↗
PubMed1997

Oral contraceptive treatment inhibits the normal acquisition of bone mineral in skeletally immature young adult female monkeys.

The purpose of the present study was to determine the effects of oral contraceptive therapy on bone density and serum markers of bone metabolism in a prospective, longitudinal study of young adult female cynomolgus monkeys. Two hundred and seven intact cynomolgus monkeys were randomized to two groups, and fed an atherogenic diet containing either no drug (Control) or a triphasic oral contraceptive regimen (Contraceptive). Measurements of bone density were carried out by dual-energy X-ray absorptiometry at 10-month intervals (0, 10, and 20 months) and serum bone biomarkers were determined at 5-month intervals over the 20-month time course. No significant differences in these variables were observed prior to treatment. Both groups of animals gained bone mineral during the study, indicating that peak bone mass had not been reached at baseline. Contraceptive-treated animals gained less spinal (lumbar vertebrae 2-4) bone mineral content and density and less whole-body bone mineral content than Controls over the course of the study. Significant depressive effects of contraceptive treatment on gains in BMC and BMD were observed during each 10-month interval of the study. Bone metabolism was inhibited in the Contraceptive group, as reflected by marked reductions (approximately 40%) in serum osteocalcin and alkaline phosphatase levels along with moderate reductions in serum acid phosphatase and calcium. The results suggest that triphasic oral contraceptive treatment of young adult female monkeys that have not reached peak bone mass inhibits net bone accretion and/or growth by reducing bone metabolism. Thus, prolonged continuous oral contraceptive use in skeletally immature females may lead to a lower peak bone mass--an effect which could increase the risk of fractures in later life.

Absorptiometry, Photon↗
PubMed2000

Declining ovarian cancer rates in U.S. women in relation to parity and oral contraceptive use.

Ovarian cancer incidence and mortality rates have declined among U.S. women age 35-59 years during the period 1970-1995. Epidemiologic studies have shown that ovarian cancer risk decreases with increasing parity and increasing duration of oral contraceptive use. During this period, parity has declined while oral contraceptive use has increased. We compared temporal trends in observed ovarian cancer incidence rates with rates predicted by changes in parity and duration of oral contraceptive use to determine whether the changes in these characteristics could explain the declining rates in younger women. In addition, we wished to examine whether oral contraceptive use continues to be protective to postmenopausal women. To predict changes in rates between 1970 and 1995, we assumed that increases in parity and duration of oral contraceptive use induce proportional decreases in incidence rates. We found that the rates predicted by these assumptions agreed well with observed rates in young women (age 30-49) but were substantially lower than observed rates in older women (age 50-64). The data indicate that the relative decrease in incidence rates due to the protective effect of oral contraceptive use declines with age.

Adult↗
PubMed2006

Biphasic versus triphasic oral contraceptives for contraception.

BACKGROUND: Side effects caused by oral contraceptives discourage compliance with, and continuation of, oral contraceptives. A suggested disadvantage of biphasic compared to triphasic oral contraceptive pills is an increase in breakthrough bleeding. We conducted this systematic review to examine this potential disadvantage. OBJECTIVES: To compare biphasic with triphasic oral contraceptives in terms of efficacy, cycle control, and discontinuation due to side effects. SEARCH STRATEGY: We searched MEDLINE, EMBASE, POPLINE, LILACS and CENTRAL. We searched the reference lists of relevant articles and book chapters. We also contacted the authors of relevant studies and pharmaceutical companies in Europe and the USA. SELECTION CRITERIA: We included randomized controlled trials comparing any biphasic with any triphasic oral contraceptive when used to prevent pregnancy. DATA COLLECTION AND ANALYSIS: We examined the studies found during the searches for possible inclusion and assessed methodological quality using Cochrane guidelines. We contacted the authors of included studies and of possibly randomized studies for supplemental information about the methods and outcomes. We entered the data into RevMan. We calculated Peto odds ratios for incidence of discontinuation due to medical reasons, intermenstrual bleeding, and absence of withdrawal bleeding. MAIN RESULTS: Only two trials of limited quality met our inclusion criteria. Larranaga 1978 compared two biphasic pills and one triphasic pill, each containing levonorgestrel and ethinyl estradiol. No important differences emerged, and the frequency of discontinuation due to medical problems was similar with all three pills. Percival-Smith 1990 compared a biphasic pill containing norethindrone (Ortho 10/11) with a triphasic pill containing levonorgestrel (Triphasil) and with another triphasic containing norethindrone (Ortho 7/7/7). The biphasic pill had inferior cycle control compared with the levonorgestrel triphasic. The odds ratio of cycles with intermenstrual bleeding was 1.7 (95% CI 1.3 to 2.2) for the biphasic compared with the triphasic levonorgestrel pill. The odds ratio of cycles without withdrawal bleeding was 6.5 (95% CI 3.1 to 13). In contrast, cycle control with the biphasic pill was comparable to that of the triphasic containing the same progestin (norethindrone). AUTHORS' CONCLUSIONS: The available evidence is limited and the internal validity of these trials is questionable. Given the high losses to follow up, these reports may even be considered observational. Given that caveat, the biphasic pill containing norethindrone was associated with inferior cycle control compared with the triphasic pill containing levonorgestrel. The choice of progestin may be more important than the phasic regimen in determining bleeding patterns.

Contraception↗
PubMed2002

Biphasic versus triphasic oral contraceptives for contraception.

Side effects caused by oral contraceptives discourage compliance with and continuation of oral contraceptives. A suggested disadvantage of biphasic oral contraceptive pills compared to triphasic oral contraceptive pills is an increase in breakthrough bleeding. We examined this potential disadvantage by conducting a systematic review comparing biphasic oral contraceptives with triphasic oral contraceptives in terms of efficacy, cycle control, and discontinuation because of side effects. We included randomized, controlled trials comparing any biphasic oral contraceptive with any triphasic oral contraceptive when used to prevent pregnancy. Only two trials of limited quality met our inclusion criteria. Larranaga compared two biphasic and one triphasic pills, each containing levonorgestrel and ethinyl estradiol. No important differences emerged, and the frequency of discontinuation because of medical problems was similar with all three pills. Percival-Smith compared a biphasic pill containing norethindrone (Ortho 10/11) with a triphasic pill containing levonorgestrel (Triphasil) and another triphasic pill containing norethindrone (Ortho 7/7/7). The biphasic pill had inferior cycle control compared with the levonorgestrel triphasic pill. The available evidence is limited and of poor quality; the internal validity of these trials is questionable. Given that caveat, the biphasic pill containing norethindrone was associated with inferior cycle control compared with the triphasic pill containing levonorgestrel. This suggests that the choice of progestin may be more important that the phasic regimen in determining bleeding patterns.

Contraception↗
PubMed1992

Menorrhagia. Current drug treatment concepts.

Since menorrhagia occurs in 9 to 14% of populations of healthy women, many general practitioners will encounter menorrhagia-related problems. Menorrhagia is difficult to objectify and the choice of treatment between the available drugs is not always an easy one. In this survey, the available knowledge on menorrhagia diagnosis, underlying pathophysiology and treatment, especially medicinal treatment, are discussed. Overall, a practical approach is emphasised. The desire for contraception as well as the underlying cause of menorrhagia determine the drug of choice in the treatment of menorrhagia. If contraception is desired, oral combination contraceptives and continuously dosed progestogens, orally or as a medicated intrauterine device (IUD), are the first choice drugs for essential menorrhagia, and for fibroid- and bleeding disorder-associated menorrhagia. If no contraception is desired, the first choice treatments are drugs that need to be administered only during menstruation, such as prostaglandin synthesis inhibitors or antifibrinolytics. Of these, antifibrinolytics reduce menstrual blood loss to the greatest extent, whereas prostaglandin synthesis inhibitors have the lowest incidence of side effects. Prostaglandin synthesis inhibitors also have the extra advantage of diminishing dysmenorrhoea. There is no place for ergometrine in the treatment of menorrhagia. No studies are available as yet on the combination of various drug treatment modalities, although such an evaluation would be desirable.

Female↗
PubMedDate not supplied

Cervical cytology associated with levonorgestrel contraception.

Cytologic monitoring of cervical smears was carried out in 686 women receiving two modes of levonorgestrel contraception, one in the form of a subdermal implant and the other as an intrauterine device. The period of contraception with both delivery systems ranged from six months to five years. No case of malignant neoplasia was seen in any of the 44 subjects even after five years of continued levonorgestrel contraception. Preinsertion cytology revealed eight dysplastic smears (seven mild and one moderate); the lesions reverted to normal six months later and remained normal after one to four years of hormone use. A total of 19 dysplastic smears (18 mild and 1 moderate) were detected in the postinsertion smears collected after one to five years of contraception, giving an incidence of 2.8%, which was nonsignificant when compared with the control figure of 1.3%. Regression of the lesion to normal was observed in all 19 dysplasias on follow-up and in none did the dysplasia progress to a higher grade or frank malignancy. The incidence of dysplasia was more than twice as high with the intrauterine device as with the implant (4.9% vs. 2.1%). Hence, the implant appeared to be safe during five years of contraceptive use in terms of cervical pathology. However, longer follow-up of a large number of women is needed to reach a definitive conclusion.

Adult↗
PubMed1985

Contraceptive decision-making in urban, black female adolescents: its relationship to cognitive development.

Contraceptive education and accessible contraceptive methods have not reduced significantly the incidence of adolescent pregnancy. The cognitive development of adolescents makes contraceptive decision-making difficult. This study examined how cognitive development affected contraceptive decision-making among 86 urban black female adolescents attending three family planning clinics. Hierarchical multiple regression analyses revealed that the stage of cognitive development was the best predictor of contraceptive decision-making. Age and relevant sexual knowledge added to the explanation of decision-making variance. Potential nursing implications include: (1) screening of stage cognitive development prior to rendering care, (2) continuation of contraceptive education and (3) presentation of contraceptive education at appropriate cognitive levels.

Adolescent↗
PubMed1979

[Hormonal contraception (author's transl)].

Hormonal contraceptives will continue to be used for some time to come as the safest means by which to prevent pregnancy. This is the background against which an account is given of the forms of hormonal contraception, their safety, selection of preparations, prescription for young people, side-effects, contra-indication to prescription, and indication for discontinuation.--In the context of side-effects, particular reference is made to the effects of steroids upon fat, carbohydrate, and protein metabolism, the cardiovascular system, and early pregnancy.

Cardiovascular Diseases↗
PubMed1996

Contraception for the older woman.

Contraception presents particular problems for women over the age of 40. Although fertility is declining and the risk of pregnancy may be small, the consequences of an unplanned pregnancy may be socially devastating and medically ill-advised. Menstrual dysfunction and psychosexual difficulties increase with age and may exacerbate the side-effects of some methods of contraception. The long-term risks of combined hormonal contraception, particularly cardiovascular disease, become more pertinent to women whose natural risk of disease increases with age. Patterns of sexual activity and contraceptive use change with age. The advantages and disadvantages of currently available methods of contraception are difficult to quantify, and the choice of method is very much a matter for individual concern. The increasing prevalence of HRT may complicate matters for some women who are unsure for how long to continue using contraception. Contraceptives of the future may be designed to improve the reproductive health of all women, particularly those approaching the menopause.

Adult↗
PubMed1996

Contraceptive use among female adolescents.

Teenage pregnancy continues to be a problem in the United States despite the availability of reliable contraceptive methods. A pilot study was conducted to determine the use of reliable contraception by teenagers following an abortion or negative pregnancy test. The results indicated that 96.6% of the teenagers experiencing a therapeutic abortion and 49.6% of the teens having a negative pregnancy test reported choosing reliable contraception after the procedure or the test. At a subsequent clinic visit, however, only 27.5% in the abortion group and 5.7% in the negative pregnancy test group reported use of reliable contraception. Further research is needed to identify factors involved in teenagers' use or nonuse of contraception.

Abortion, Legal↗
PubMed2003

A randomized clinical trial of treatment of clomiphene citrate-resistant anovulation with the use of oral contraceptive pill suppression and repeat clomiphene citrate treatment.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness and endocrine response of oral contraceptive ovarian suppression followed by clomiphene citrate in patients who previously were clomiphene citrate resistant. STUDY DESIGN: Forty-eight patients from a private tertiary infertility clinic were assigned randomly prospectively to either group 1 (oral contraceptive/clomiphene citrate), which received continuous oral contraceptives followed by clomiphene citrate, or to group 2 (control) received no treatment in the cycle before clomiphene citrate treatment. On day 3, 17 beta-estradiol, follicle-stimulating hormone, luteinizing hormone, and androgens were assayed before and after treatment. Follicle growth, ovulation, and pregnancy were evaluated. The Student t test and analysis of variance were used for statistical significance. RESULTS: The oral contraceptive/clomiphene citrate group had a significantly higher percentage of patients who ovulated and of ovulatory cycles and pregnancies. Significantly lower levels of 17 beta-estradiol, luteinizing hormone, and androgen levels were seen in the oral contraceptive/clomiphene citrate group, with no significant changes in group 2. CONCLUSION: Suppression of the ovary with oral contraceptives results in excellent rates of ovulation and pregnancy in patients who previously were resistant to clomiphene citrate. The decreases in ovarian androgens, luteinizing hormone, and 17 beta-estradiol may be responsible for the improved response.

Adult↗
PubMed1997

Contraceptive practices before and after an intervention promoting condom use to prevent HIV infection and other sexually transmitted diseases among women--selected U.S. sites, 1993-1995.

Because heterosexual contact is the most common mode of human immunodeficiency virus (HIV) transmission among women, development of effective strategies to reduce sexually transmitted HIV infection is critical. In addition, because most women at risk for HIV infection are reproductive aged (14-44 years), effective use of contraceptives is important to prevent unintended pregnancies. Latex condoms used by males, when used consistently and correctly, are highly effective at reducing the risk for HIV infection and other sexually transmitted diseases (STDs); however, hormonal contraceptive methods or surgical sterilization are more effective for preventing pregnancy. One possible effect of encouraging women to use condoms for HIV/STD prevention with their male partners is that women may discontinue use of hormonal contraceptive methods. To assess whether encouraging women to use condoms for HIV/STD prevention affects their contraceptive practices, CDC analyzed longitudinal data on contraceptive methods and condom use for HIV/STD prevention that were collected as part of a randomized trial evaluating HIV-counseling methods during August 1993-June 1995. This report summarizes the findings of the analysis, which indicate that, among reproductive-aged women who were encouraged to use condoms for HIV/STD prevention, consistent condom use for HIV/STD prevention increased among women using each contraceptive method studied. In addition, most women using hormonal contraceptive methods continued to use them after the intervention, and the overall proportion of women protected against pregnancy increased.

Adolescent↗
PubMed1993

Combined oral contraception with desogestrel/ethinyl estradiol: tolerability profile.

Since their introduction nearly 30 years ago, oral contraceptives have been widely researched regarding their contraceptive and noncontraceptive effects. With proper usage, oral contraceptives provide highly effective contraception. In addition, oral contraceptives confer significant noncontraceptive health benefits, including prevention of ovarian and endometrial cancer and reduction in the incidence of pelvic inflammatory disease, endometriosis, benign breast disease, and dysmenorrhea, among others. Today's low-dose oral contraceptives have an improved safety profile when contrasted with their early higher dose counterparts. Yet oral contraceptive use continues to be associated with a variety of minor side effects, which range from menstrual changes such as breakthrough bleeding, spotting, or amenorrhea, to androgenic effects, including weight gain and acne. These androgenic effects are important factors in patient discontinuation of oral contraceptives. Progestins with increased selectivity have the potential to cause fewer androgenic side effects while retaining appropriate progestin suppression of the endometrium and hypophyseal-pituitary-ovarian axis. A combination oral contraceptive (30 micrograms of ethinyl estradiol with 150 micrograms of desogestrel) has been evaluated extensively by European investigators. This literature suggests that a low-dose oral contraceptive formulated with the selective progestin desogestrel offers a favorable profile of reduced androgenic side effects while retaining the cycle control associated with low-dose oral contraceptives currently marketed in the United States.

Acne Vulgaris↗
PubMed1984

[A contraceptive social marketing (CSM) program needs continuity of management: the Asociacion Demografica Salvadorena (ADS) in 1983].

The Association Demografica Salvadorena (ADS) learned an important lesson during 1983--a contraceptive social markeing (CSM) program needs continuity of management to ensure that all components remain inegrated and all actions are coordinated within the organization. Ever since in early 1983, ADS has not had an executive specifically assigned to run the CSM project and make the important month-by-month, tactical decisions that keep a program's activities focused on meeting sales goals. Instead, executive tasks were delegated on an ad hoc basis to ADS' administrative staff. Fortunately, the program's administrative design was well-developed, and ADS' dedicated personnel were able to effectively accomplish the daily business of keeping records and getting products out to retailers. Advertising, promotion and product development suffered, however. So the new executive or general manager will need to examine these areas 1st. Although El Salvador's CSM operates in unstable social and economic conditions, and despite a dramatic fall in condom sales last year, the ADS can still do much to increase its couple years of protection at costs significantly lower than those of clinic and community-based distribution systems. Research done thus far indicates a substantial demand for ADS products. Consequently, while not set in ideal conditions, physical distribution and marketing functions can be accomplished. But, as the ADS has discovered, even with a strong leader like Dr. Gustavo Argueta, CSM enterprises do not function automatically. Producing projected sales goals depends on the continuity of "hands-on" management.

Americas↗