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PubMed1985

Vitamin supplements to Indian women using low dosage oral contraceptives.

Effect of continuous and intermittent vitamin supplements on vitamin status, serum proteins and lipids were examined in Indian women of low-income group, receiving a low-dose oral contraceptive over a period of 3-6 months. To find out non-specific time related changes, vitamin supplemented and unsupplemented control groups of non-OC users were also examined. OC treatment did not change serum chemistry significantly. The significant biochemical changes were: altered tryptophan metabolism and elevated plasma vitamin A levels. Former could be prevented by administering multivitamins containing 10 mg vitamin B6 daily or twice the dose daily for the 7 non-hormone days in the cycle. Vitamin supplements produced significant improvement in pre-existing deficiencies of riboflavin, pyridoxine and folic acid. Continuous supplementation regimen was slightly superior, but more expensive than the intermittent supplementation regimen. In view of the high prevalence of vitamin deficiency among the low-income group women of developing countries, the delivery system for oral contraceptive can be effectively used for giving vitamin supplements as well.

Adult↗
PubMed1996

Norplant implants acceptability and user satisfaction among women in two African countries.

An analysis of 350 users of Norplant contraceptive subdermal implants from six centers in two African countries (Ghana and Nigeria) indicates that method acceptability remained high among the women who used the method for five years. Overall, 90.1% of the 155 five-year users in these countries reported having a very favorable experience and 9.9% a favorable experience with Norplant implants. Ease of use was cited by 56.1% and duration of use by 13.6% of the women as the most liked characteristics of the method at study completion after five years. Menstrual disturbance was the least liked aspect, by 41.9% of the women. On average, women who discontinued early from the study had fewer living children and were more likely to desire additional children at method adoption than those who completed five years of use; the differences were statistically significant. Differences in level of education and previous use of contraception were not found to be statistically significant between completers and non-completers. Differences in age were not significant in Nigeria, but were marginally significant in Ghana, with completers being older than non-completers. Of the clients who completed this study, 79.2% indicated a desire to continue with contraception and 43.9% planned to have a second set of implants inserted. These findings have important implications for counseling, method access and service sustainability in African countries.

Adult↗
PubMed1992

Oral contraceptive use and cervical intraepithelial neoplasia.

To explore the somewhat controversial relationship between oral contraceptives and pre-invasive cervical cancer, 103 cases of biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or CIN III were compared with 258 controls who had normal cervical cytology. Cases were slightly less likely than controls to have ever used oral contraceptives; the odds ratio, controlling for age, socioeconomic status, barrier method use, smoking history, age at first sexual intercourse, number of sex partners, current marital status, and number of Pap smears, was 0.7 (95% CI 0.3-1.6). Recency, latency, duration, and age at first oral contraceptive use were evaluated and in no instance was oral contraceptive use positively associated with CIN. This study adds to the body of knowledge that oral contraceptives are not associated with pre-invasive cervical cancer. Further, if oral contraceptive users continue to be regularly screened, their risk of developing the more invasive lesions should be very low.

Adolescent↗
PubMed1990

[Natural conceptive probability in normal married women].

A total of 1,974 married couples were investigated for natural conception rate and the time required to become pregnant after cessation of contraceptive measure. Among them, 33 couples were infertile due to various causes and 52 couples employed contraceptive method continuously. Therefore, the time intervals of natural conception were available for analysis only in 1,889 couples. Fourteen hundred and sixty-seven women (77.6%) became pregnant within 3 months after exposure to the risk of conception, 1,683 (89.0%) within 6 months, 1,793 (94.8%) within one year and 1,855 (98.0%) within 2 years. The correlations among conceptive probability, history of using contraceptive methods, age of marriage, and menstrual status were discussed.

Adult↗
PubMed2006

Effect of the menstrual cycle and oral contraceptives on aromatase and cyclooxygenase-2 expression in adenomyosis.

OBJECTIVES: To determine whether aromatase expression in the eutopic endometrium and adenomyotic foci is affected by previous use of oral contraceptives containing gestodene, and to determine whether changes in cyclooxygenase-2 (COX-2) expression occur in adenomyosis during the menstrual cycle. PATIENT AND METHODS: This was a retrospective cohort study carried out in paraffin-embedded endometrial tissue obtained from patients with a histological diagnosis of adenomyosis obtained during the proliferative (n = 25) and luteal (n = 10) phases of the menstrual cycle and following the use of continuous oral contraception with gestodene/ethinyl estradiol (n = 7). COX-2 and aromatase expression were measured in both eutopic endometrium and adenomyotic foci using immunohistochemical methods. RESULTS: Aromatase expression was detected in 80% of the endometrial slices by immunohistochemistry. In positive cases, aromatase was mainly detected in the stromal cells of the eutopic endometrium, whereas in the adenomyotic foci this expression was negative in the majority of the cases. Oral contraceptives containing gestodene, on the other hand, were effective in suppressing aromatase expression in both eutopic and ectopic endometrium. COX-2 expression was detected by immunohistochemistry in the glandular epithelium of both eutopic endometrium and adenomyotic foci and there were no significant changes in its intensity throughout the menstrual cycle. CONCLUSION: Aromatase expression in the eutopic endometrium and adenomyotic foci is suppressed by oral contraceptives containing gestodene. Increased aromatase activity may be responsible for the persistent COX-2 expression during the luteal phase.

Adult↗
PubMed1980

Adolescent contraceptive use: experience in 1,762 teenagers.

Retrospective analysis was done on 1,762 adolescent family planning patients who used the St. Paul Maternal and Infant Care Project Teen Clinic from 1969 through June 1979. Factors evaluated included method of contraception, demographic data, and continuation rates calculated by Life Table Method. A further comparison was done on 403 of these patients who initiated their family planning care at a project satellite clinic located within a local high school.

Adolescent↗
PubMed1980

[Oral contraceptives and benign tumorous conditions of the liver (author's transl)].

Tumorous lesions of the liver were diagnosed by means of angiography, sonography and laparoscopy in six patients on oral contraceptives for a long time. These lesions were identified as liver cell adenoma (1), focal nodular hyperplasia (4) and cavernous hemangioma (1). The relationship between oral contraceptives and liver disorders is well-known. All cases of focal nodular hyperplasia show vascular alterations which may be important in the discussion of oral contraceptives being responsible. In contrast to liver cell adenoma and hemangioma, focal nodular hyperplasia may be considered as a nodular reparative regeneration of the parenchyma following focal parenchymal necrosis due to segmental vascular occlusion (i. e. thrombosis or fibrotic intimal obliteration). This lesions can therefore not be defined as a true neoplasm. The clinical findings are uncharacteristic, whereas selective hepatic artery angiography, shows typical features that distinguish liver cell adenoma from focal nodular hyperplasia. Regular medical examinations are recommended for women on continuous oral contraceptives for more than five years, because this group of patients is threatened by serious sequelae including intrahepatic and abdominal hemorrhage.

Adenoma↗
PubMed1976

Contraception with norethindrone 0.35 mg administered continuously.

Microdose norethindrone (0.35 mg taken each day without interruption) was used as an oral contraceptive agent by 168 women for 4,264 months over a five-year span. Seven pregnancies occurred with regular use and two with irregular use, resulting in a drug-effectiveness rate of 1.9 and a use-effectiveness rate of 2.5 per 100 woman-years. Cycle length was variable. During the five years of study there was a tendency toward weight gain, but no definite trend in blood pressure changes was noticed; however, there were no comparable control groups for these latter two observations. Results of metyrapone tests done after 17 to 33 months of treatment were normal.

Blood Pressure↗
PubMed1977

Male contraception.

Although the modern era of contraception has focused attention on the female, research into male contraception is continuing on several fronts. Despite the widespread use of premature withdrawal, the condom and vasectomy, there is no acceptable drug for controlling fertility in the male. New advances have been made in influencing the maturation and fertility capacity of sperm. Techniques are being developed for reversibly blocking sperm transport. The functions of seminal fluid are under intensive investigation.

Antispermatogenic Agents↗
PubMed1989

Oral contraception and post-operative thromboembolism: an epidemiological review.

It has been stated that oestrogen-containing oral contraceptive medication should be discontinued one month prior to surgery, to avoid an increased incidence of post-operative thromboembolism. Others have suggested that the risk of post-operative morbidity is low compared with the risk of pre-operative pregnancy, and that in most cases no such action should be taken. The evidence from clinical investigation is reviewed, with particular reference to study design. It is found that all studies so far conducted are subject to sources of bias or confounding which render their results inconclusive. There is a need for a randomised control trial comparing the effects of discontinuing or continuing oral contraception prior to surgery. Meanwhile, with a post-operative risk inferred but not conclusively demonstrated, if oral contraception is to be withdrawn prior to surgery, great care must be taken to reduce the risk of ensuing pregnancy to as near zero as possible.

Adolescent↗
PubMed1996

Five-year evaluation of safety, efficacy and acceptability of Norplant implants in Nepal.

This paper presents findings based on a five-year, noncomparative study of Norplant contraceptive subdermal implants in Nepal. The study was designed to evaluate the contraceptive safety, efficacy, and overall acceptability of Norplant. Four hundred and seven women enrolled in the clinical trial, which began in 1985, at two study sites, located in Patan and Kathmandu. Follow-up visits were scheduled at 1, 3 and 6 months after Norplant insertion and every six months thereafter until removal or at the end of five years. Although five pregnancies were reported during the study, only two women (one from each center) were diagnosed as becoming pregnant while using Norplant. The pooled gross cumulative life-table pregnancy rate was 0.6 per 100 women at the end of five years. The pooled cumulative continuation rate was 62 per 100 women at the end of five years. The three most frequently reported reasons for discontinuation were menstrual problems, personal reasons, and medical reasons. Of the 125 women who completed a five-year user satisfaction questionnaire, the majority of the women (86%) planned to continue using contraception after study completion. Of these women, almost one half said they planned to use a second Norplant set. The findings suggest that the Norplant system is a safe, effective, and acceptable method of contraception among Nepalese women.

Adolescent↗
PubMed1979

IUD compared with oral contraception in nulliparae.

172 nulliparae attending a Swedish family planning clinic were studied. Doctors and midwives with various experiences gave the contraceptive method. Continuation rate at 12 months was 58 per cent for IUD and 86 per cent for OC. The expulsion rate in the IUD group was 11 per cent and in 30 per cent of IUD users the device was removed because of adverse effects. 10 per cent of the IUD group and 5 per cent of the OC group discontinued their method without introducing another one, thereby risking an unwanted pregnancy.

Adolescent↗
PubMedDate not supplied

Introductory small cash incentives to promote child spacing in India.

The Ammanpettai Family Welfare Program began in 1985 as a pilot program to determine whether offering small monthly cash incentives for a limited period would be a cost-effective way to increase the use of modern temporary methods of contraception among rural Indian women who do not want to become pregnant but are not ready to adopt sterilization. The program has demonstrated that a modest cash incentive for 3-5 months attracts very large numbers of women to a clinic where they learn about and are provided with the pill, condoms, or the IUD. In catchment areas where official government reports showed temporary-methods prevalence rates of 3-5 percent at best, the Ammanpettai incentive program has attracted up to 70 percent of eligible women to join the program and try the method of their choice. By requiring that participants bring their youngest child to the clinic, the program provides for mother and child health surveillance, including immunizations. The great majority of rural women who join the program work as field laborers, have little or no schooling, and have little knowledge of or experience with modern contraceptive methods. Continuation rates are 25-50 percent at one year if follow-up is maintained by village resident women distributors. The program has been extended to several rural primary health centers in Thanjavur District, to 14 government health posts in the city of Madras, and to a semiurban area and several rural areas in Bihar. The cost-effectiveness of this program compares favorably with that of the current government family welfare program.

Adult↗
PubMed2000

Isolated tubal torsion at menarche- a case report

Background: Adnexal torsion is a well-recognized cause of acute pelvic pain. Isolated tubal torsion with ovarian sparing has certainly been documented, but is uncommon. Although risk factors for the latter include a menstrual period, menarche in particular is not known to predispose a patient to this event. Severe unilateral pelvic pain with first menses is more likely to herald a congenital mullerian anomaly and cryptomenorrhea, particularly when accompanied by a pelvic mass. We present a case of tubal torsion where a coincidental, yet misleading temporal relation to menarche led to a delay in laparoscopy and ultimate diagnosis.Case: KG, an eleven-year-old female, experienced severe right-sided dysmenorrhea with her first and second menses in August and September 1999 respectively. Between episodes, pain, although still present, was more tolerable and the patient never required hospitalization. Ultrasound revealed a lobulated inhomogeneous mass posterior to the uterus and extending from one normal ovary to the other (Figures). MRI further described the mass as pseudoencapsulated with inhomogeneous areas of high attenuation on T1 and T2 images (Figures). Findings were consistent with an endometrioma, but admittedly could have represented a hemorrhagic cystic mass. No definite mullerian anomaly was seen to explain advanced endometriosis, but two focal areas within the endometrial canal raised the possibility of a uterine septum. Examination of the patient (one week after presentation) was not very helpful although she was pubertal, did have a hymenal septum and was mildly tender on bimanual examination in the Pouch of Douglas. The patient had been started on continuous oral contraceptives while undergoing investigations. Pain only recurred during an episode of break-through bleeding. Ultimately she came to laparoscopy and hysteroscopy where chronic right tubal torsion and necrosis was identified with an inflammatory/hemorrhagic reaction in the pelvis (Photos). There were no identifiable fimbria of the right tube which was densely adherent distally to perirectal fat (Photo). No obvious precipitant was found. Laparoscopic lysis of adhesions and right distal salpingectomy was performed (Photo). Her uterine cavity was in fact normal (Photo)Conclusion: Whether or not this patient's right tube was originally normal will never be known. Congenital abnormalities of fallopian tubes do occur and can predispose to torsion. Nonetheless, adnexal torsion must always be kept in mind whenever a woman presents with unilateral pelvic pain. Early diagnosis is paramount in children and women of reproductive age in order to improve the likelihood of adnexal salvage and future fertility. A "gold-standard" radiological investigative tool continues to elude us. Laparoscopy, albeit more invasive, remains an invaluable procedure in this context with relatively low morbidity as compared to the consequences of delayed diagnosis.

Journal Article↗
PubMed2004

Clinical profile of contraceptive progestins.

The term progestogen has been widely utilized to indicate the general class of agents that includes both progesterone and its synthetic analogs, whereas the term progestin refers only to synthetic progestational steroids. The development of progestins has been influenced in a major way by the search for orally active hormonal contraceptives, since it is likely that hormonal contraceptives will continue to utilize a progestin, the only possible alternative being represented by the utilization of antiprogestins. Synthetic progestogens in clinical use today belong to three main chemical families: progesterone derivatives (progesterone, retro-progesterone, 19-norprogesterone and 17alpha-hydroxyprogesterone); gonane and 19-nortestosterone derivatives (norethisterone, levonorgestrel, desogestrel, gestodene, norgestimate); a spironolactone derivative. Biological potency of progestogens varies depending on the end-point measured, usually ovulation inhibition and endometrial transformation; with both these tests, the most active compounds are all gonane derivatives, with a potency over a 100 times that of the natural hormone. When administered in adequate doses, a progestin inhibits fertility by inhibiting ovulation. This action is mainly exerted at the hypothalamic level where, physiologically, progesterone decreases the number of LH pulses. When progestogens are delivered directly to the uterine cavity, their action seems to be purely local. It has been amply proven that--even when administered in doses that do not constantly inhibit ovulation--a progestin can still remain effective as a contraceptive by acting at the level of the cervical mucus and, at least in part, of the endometrium. Progestogens utilized today differ largely in their pharmacokinetics. In general, after intake, these compounds are rapidly absorbed and distributed so that peak serum concentrations are reached between 1 and 4 h. Third-generation progestins (desogestrel, gestodene, norgestimate) have common characteristics: a higher affinity for progesterone receptors than their predecessors, a lower affinity for androgen receptors, a higher selectivity of action, a higher central inhibitory activity, a higher potency at the level of the endometrium, and an overall metabolic neutrality, in terms of effects on lipid and carbohydrate metabolism. In general, progestins can induce two types of adverse effects: changes in lipid metabolism and bleeding irregularities. Whereas the newer compounds seem to have overcome the first of these adverse effects, the second remains untouched: to this day, proper cycle control can only be achieved with combined hormonal contraceptives.

Contraceptive Agents↗
PubMed1989

[Oral contraceptives and blood diseases are the most common causes of Budd-Chiari syndrome].

Two cases of young patients with the chronic form of Budd-Chiari syndrome are reported. The first concerns a 22-year-old woman with a 6-month history of hepatomegaly, who had used oral contraceptives almost continuously during the five years preceding diagnosis. In a thorough diagnostic work-up, thromboses were detected in all but one of the hepatic veins, and a possible non-occluding thrombosis in the retrohepatic portion of the inferior vena cava. In the blood and bone marrow, findings were compatible with polycythaemia rubra vera, and a high anti-cardiolipin antibody titre was found. The second case concerns a 25-year-old male smoker with normal bone marrow, who had thromboses in at least two of the hepatic veins, though the inferior vena cava was not occluded. In both cases a mesocaval shunt was interposed with synthetic grafts, and postoperatively the patients are doing well--at sixteen and five months, respectively. Both are maintained on anticoagulants, and even without diuretics there has been no recurrence of ascites. The woman takes a small dose of hydroxy-urea to control her hypercoagulability. To our knowledge, hers is the first case to be reported of Budd-Chiari syndrome with hypercoagulability due to the concomitant presence of oral contraceptives, polycythaemia rubra vera and anti-phospholipid antibodies.

Adult↗
PubMed2005

Exploiting common targets in human fertilization and HIV infection: development of novel contraceptive microbicides.

The continued high rates of unintended pregnancies and the unrelentless expansion of the acquired immune deficiency syndrome (AIDS) epidemic, especially in less developed countries, warrant the development of novel strategies to help individuals avoid these risks. Dually active compounds displaying contraceptive and microbicidal anti-human immunodeficiency virus (anti-HIV) properties constitute one such strategy. Sharing the same anatomical and functional context, sperm fertilization and genital infection by HIV offer an opportunity for simultaneous intervention. Some of the molecules and mechanisms used by sperm to fertilize the oocyte are similar, if not identical, to those used by HIV while infecting host cells. An example of common structures is the lipid membrane surrounding the spermatozoon and the HIV core. Disruption of its architecture by surface-active compounds exerts both spermicidal and virucidal activity. A more specific alteration of lipid rafts [membrane microdomains enriched in cholesterol and glycosylphosphatidylinositol (GPI)-anchored proteins] by beta-cyclodextrins also results in similar effects. During fertilization and infection, both sperm and HIV interact with their target cell receptors through chemical charges, hydrophobic forces and carbohydrate recognition. Anionic polymers such as cellulose sulphate and polystyrene sulphonate (PSS) inhibit sperm and HIV cell binding. Because some of the molecules involved in this interaction, e.g. heparin sulphate proteoglycan, are also used by other pathogens to infect their target tissues, polyanions exert broad antimicrobial activity as well. During fertilization and infection, sperm and HIV, as well as other microbes, use signal transduction molecules and mechanisms such as adenyl cyclase/cyclic adenosine monophosphate (cAMP)-dependent kinase, calcium and tyrosine phosphorylation, whose inhibition has been shown to impair sperm function and HIV replication. These commonalities at the level of sperm and HIV structure, cell binding and fusion processes, and signalling pathways therefore provide the biological framework to develop bifunctional inhibitors with both antimicrobial and contraceptive properties.

Anti-HIV Agents↗