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PubMed1999

Estimates of the risk of cardiovascular death attributable to low-dose oral contraceptives in the United States.

OBJECTIVE: Our purpose was to estimate the annual risk of death in the United States from cardiovascular disease attributable to low-dose combination oral contraceptives. STUDY DESIGN: Estimates of the risk of death from cardiovascular disease attributable to low-dose oral contraceptives were modeled on data from studies published through 1997 and from age-specific mortality rates in the United States for 1993 and 1994. RESULTS: Attributable risk of death from cardiovascular disease resulting from oral contraceptive use is 0.06 and 3.0 per 100,000 nonsmokers 15 to 34 years of age and 35 to 44 years of age, respectively. In smokers this risk increases, respectively, to 1.73 and 19.4 per 100,000 users in these 2 age groups; however, 97% and 85% of this risk is due to the combined effects of smoking and using oral contraceptives. The attributable risk of death from cardiovascular disease in nonsmoking oral contraceptive users is lower than the risk of death from pregnancy in nonusers of oral contraceptives at all ages; however, among smoking oral contraceptive users more than 35 years of age, the excess risk of death from oral contraceptives is higher than the risk of death from pregnancy. CONCLUSION: There is virtually no excess attributable risk of death from cardiovascular disease related to oral contraceptive use in young women. However, smokers more than 35 years of age should use a nonestrogen contraceptive.

Adolescent↗
PubMed1997

Influence of oral contraceptive use and cigarette smoking, alone and together, on antipyrine pharmacokinetics.

The pharmacokinetics of antipyrine following a single 1-g intravenous dose was determined in 63 healthy women. Subjects were divided into 4 groups as follows: 1) cigarette smokers using low-dose oral contraceptives (n = 15); 2) nonsmokers using low-dose oral contraceptives (n = 12); 3) cigarette smokers not using oral contraceptives (n = 10); and 4) controls, neither cigarette smokers nor oral contraceptive users. Plasma antipyrine concentrations during 24 to 48 hours after dosage were measured by high-performance liquid chromatography. Mean kinetic variables in the nonsmoking, non-oral contraceptive using control group were: volume of distribution, 37.7 L; elimination half-life, 13.2 hours; and clearance, 34.4 mL/min. In cigarette smoking, non-oral contraceptive users versus controls, elimination half-life was reduced (8.0 vs. 13.2 hours, P < 0.05) and clearance increased (56.0 vs. 34.4 mL/min, P < 0.05). In nonsmoker oral contraceptive users, the reverse was true (elimination half-life was significantly increased: 16.6 vs. 13.2 hours, P < 0.05; and clearance was significantly decreased: 24.8 vs. 34.4 mL/min, P < 0.05). In smokers who were using oral contraceptives, values were not significantly different from controls (elimination half-life, 11.2 hours; clearance, 39.5 mL/min). Volume of distribution did not differ among the four groups. Thus the opposing effects on antipyrine clearance of the induction of metabolism by cigarette smoking and the inhibition due to low dose oral contraceptive use in effect negate each other when combined in humans.

Adolescent↗
PubMed1982

Increased metabolic clearance of acetaminophen with oral contraceptive use.

The effect of chronic low-dose oral contraceptive steroid use on the pharmacokinetics of intravenous acetaminophen was determined. Eight women using low-dose (under 50 micrograms) estrogen oral contraceptive steroid for more than 3 months were matched for age and weight (mean age, 25.9 years; mean weight, 58.3 kg) with 8 female controls not using the steroid (mean age, 26.0 years; mean weight, 55.5 kg). No subject was taking other drugs. Oral contraceptive steroid subjects had a lower elimination half-life of acetaminophen (2.12 hours) than controls (2.71 hours) (P less than .005). Volume of distribution was similar for both groups (oral contraceptive group, 1.04 liters/kg; controls, 0.96 liters/kg; NS). Total metabolic clearance was significantly higher in oral contraceptive subjects (5.81 ml/min/kg, versus 4.12 ml/min/kg for controls; P less than .02). As volume of distribution and body weight are similar for both groups, the decrease in acetaminophen elimination half-life among contraceptive steroid users is the result of increased total metabolic clearance. Thus, low-dose estrogen oral contraceptive steroid may stimulate the metabolism of a conjugatively metabolized drug such as acetaminophen, in contrast to contraceptive steroid impairment of the clearance of some oxidatively metabolized drugs, with antipyrine being the prototype.

Acetaminophen↗
PubMed2003

Patient satisfaction and the impact of written material about postpartum contraceptive decisions.

OBJECTIVE: The purpose of this study was to evaluate the impact of written educational material about patient satisfaction and decision-making regarding postpartum contraception. STUDY DESIGN: Baseline patient satisfaction and effectiveness of contraceptive counseling on a postpartum unit was evaluated with the use of a self-administered questionnaire. Data were compared with patients who received additional comprehensive written educational material during their postpartum hospitalization. RESULTS: A total of 109 women participated in the study (control subjects, 53; intervention group, 56). Demographics and patient satisfaction with contraceptive counseling were similar between groups. Thirty-four percent of the control subjects reported having received some sort of written information; all women in the intervention group received a standardized comprehensive booklet of information during their postpartum stay (P <.01). Among the women who received written information, the intervention group was more likely to state that written material contributed to their ultimate choice in birth control (P <.01). CONCLUSION: The postpartum distribution of written material about contraceptive options increases a woman's ability to make an informed decision regarding birth control.

Adult↗
PubMedDate not supplied

A consumer intercept study of oral contraceptive users in the Dominican Republic.

Purchasers of a low-cost oral contraceptive were intercepted and interviewed in a sample of Santo Domingo pharmacies that represented the highest sales of the product, yet also reflected the socioeconomic profile of the city's entire population. Users of the contraceptive were later interviewed in greater depth in their homes. The survey of users showed that the Dominican Republic's social marketing program, implemented by PROFAMILIA, was reaching an appropriate target market--that is, younger, lower-middle-class women of low parity. The program was, in addition, successful in attracting first-time adopters, and it was also expanding the overall commercial market for all contraceptives. The marketing campaign was successful in part because a mass audience was reached, through brief television spots. Program impact on contraceptive prevalence can be assessed from sales data.

Adolescent↗
PubMedDate not supplied

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services↗
PubMed1991

Hepatic adenoma and focal nodular hyperplasia.

Hepatic adenoma and focal nodular hyperplasia are benign lesions of the liver. The incidence of these conditions has been increasing since 1970. Hepatic adenoma primarily affects young women of childbearing age who have a long history of using oral contraceptives, while focal nodular hyperplasia has a wider age distribution and is not associated with the use of oral contraceptives. The most extensive complication of hepatic adenoma is intratumoral or intraperitoneal hemorrhage, which occurs in 50 to 60 per cent of patients. Patients with focal nodular hyperplasia are usually asymptomatic and rarely experience complications. Hepatic adenoma is distinct from focal nodular hyperplasia both in its clinical behavior and its pathologic features; the two can usually be differentiated radiographically using a combination of radionuclide scanning and angiography. There is a proved association between the use of oral contraceptives and the development of hepatic adenoma; the longer the duration of oral contraceptive use, the more the risk of having hepatic adenoma develop. In addition, users of oral contraceptives who have hepatic adenoma develop are likely to have larger tumors and higher rates of bleeding and rupture than nonusers who have hepatic adenoma develop. Although hepatic adenomas may regress after discontinuation of oral contraceptive use, this is not a consistent finding. In addition, it has now been demonstrated that hepatic adenomas do undergo malignant transformation and that this can be detected by measuring the alpha-fetoprotein level. Focal nodular hyperplasia may be a precursor for fibrolamellar hepatocellular carcinoma. Elective resection of hepatic adenoma has a mortality rate of less than 1 per cent, while the mortality rate with free rupture is 5 to 10 per cent. Because of the relative safety of elective versus emergency resection and the potential for malignant change, the treatment of choice for hepatic adenoma is surgical resection.

Adenocarcinoma↗
PubMed1982

Fincoid--a new copper IUD: a preliminary report.

Fincoid, a new copper IUD, was tested on a single clinic basis in a preliminary series of 956 1st insertions and 10,015 woman-months of use with an individual follow-up of 12 months. 458 (48%) of the women were nulliparous and 498 (52%) were parous. About 1/3 of the women had previously discontinued the use of other types of IUDs (mostly copper) because of side effects. The 1st segment of net cumulative rates for the whole series were: pregnancy 1.1, expulsion 4.7, removal for bleeding and/or pain 7.6 and removal for infection 0.8. The continuation rate was 78.9 and the percentage lost to follow-up was 2.8%. The parous group had a higher continuation rate (81) than the nulliparous group (76). Rates for pregnancy, expulsion, and infection in the nulliparous group were about 2-fold the corresponding rates of the parous group. There was no difference in the removal rate for bleeding and/or pain between the 2 parity groups. The results of the study show that the Fincoid is a valid method of intrauterine contraception.

Age Distribution↗
PubMed1984

Barrier contraception.

Barrier contraception is a safe, effective, reversible form of contraception acceptable to many couples. The use of barrier contraception may protect against carcinoma of the cervix and sexually transmitted diseases. Distribution and education in the use of barrier contraception does not always require medical supervision. This must make it an attractive form of contraception for agencies supporting family planning programmes in developing countries. The only marketed recent advance in barrier contraception is the collatex sponge. Effectiveness rates range between 9 and 27 pregnancies per 100 woman-years. This is unlikely to make it the first choice of contraception for couples who would find an unintended pregnancy a severe problem, but the sponge will be acceptable to couples who are simply trying to delay a pregnancy. The new surge of interest in barrier contraception could lead to safer more effective forms of contraception being made available to women without medical supervision. This would have many advantages, but could also detract from the ability of family planning clinics to play an important role in preventative medicine for women.

Adrenergic beta-Antagonists↗
PubMed1975

Smoking, oral contraceptives, and obesity. Effects on white blood cell count.

Data from 14,961 healthy women were analyzed to determine the relative importance of factors that alter the white blood cell (WBC) count. The effects of smoking, oral contraceptive use, and obesity were most striking. A total leukocyte count greater than 10,00/cu mm was found in 44% of obese, heavily smoking women who took oral contraceptives (central 95% of the distribution was 5,800 to 14,200/cu mm) as compared to 2% of women without these attributes (3,500 to 9,400/cu mm). Other factors such as age, time of day, phase of the menstrual cycle, and red blood cell variables were of lesser significance. The use of noncontraceptive estrogenic hormones did not affect the WBC count. Recognition of these findings is important because excessive laboratory studies, lost physician time, and patient inconvenience may thereby be avoided.

Adolescent↗
PubMed1985

The relationship of self-concept and autonomy to oral contraceptive compliance among adolescent females.

Self-concept and autonomy are typically negotiated during adolescence, a time when many females also become sexually active. Nonuse and discontinuation of contraceptives by teenagers place them at high risk for pregnancy. The present study explores the relationship between these psychological factors and contraceptive noncompliance during adolescence. Fifty-five adolescent females beginning a contraceptive regimen were entered into the study. Compliance at four months after the initiation of an oral contraceptive was associated with scoring high on the Behavior Subscale of the Piers-Harris Self-Concept Scale and the Autonomy Scale modified from Eysenk.

Adolescent↗
PubMed1984

Do oral contraceptives reduce the incidence of rheumatoid arthritis? A pilot study using the Stockholm County medical information system.

The Stockholm County medical information system was used to select cases for a pilot study on the association between oral contraceptive (OC) use and the incidence of rheumatoid arthritis (RA). A selection procedure is described by which we obtained 76 cases of RA. These were compared in a case-control study with 152 healthy controls with regard to OC use prior to the onset of RA. For all women who had used OCs for more than one year the relative risk of RA was 0.70 (0.40, 1.24). The relative risk decreased with advancing age at onset of RA, being 0.40 (0.10, 1.65) for women with age at onset over 40. Although the material is small, and there are some inconsistencies in the results, our findings are compatible with the hypothesis that the use of OCs is associated with a reduced incidence of RA.

Adolescent↗
PubMed1990

[Doctors and injectable contraception. Analysis of the logistics of prescribing in accordance with the views expressed by doctors].

Injectable contraception (IC) using medroxyprogesterone acetate (Depoprovera) and norethisterone enanthate (Noristerat) has been discussed in numbers of publications since the Food and Drug Administration (FDA) of the USA have refused to authorize the use of Depoprovera as a contraceptive in America. This has provoked a large number of publications in the international literature. The refusal was based on the potential oncogenic risk of the molecule. The distribution of this product as a contraceptive in developing countries and its restricted authorisation in many industrialised countries including France has brought about contradictory debates about the assessment of this method (secondary effects, risks of developing cancer and teratogenesis). In 1986 we started a research using close collaboration between the health teams of Seine-Saint-Denis (which control clinics, family planning clinics and hospitals) in order to try to find some solution to this problem "for or against IC". The object of this research was to find out how acceptable this method was as compared with other contraceptive methods. The fact that many disciplines were involved (gynaecologists, sociologists, epidemiologists and pharmacologists) in this work made it possible first to find out the conditions under which IC was prescribed (by sociological analysis and discussions with doctors). And the socio-cultural features in which the doctors who prescribed this method of contraception were situated also came into play. The criteria under which ICs are prescribed are not mainly medical but are narrowly linked to socio-cultural factors and the socio-economic factors of the women for whom it is prescribed: and this is in comparison with other methods of contraception. Prescribing this substance has a degree of urgency about it.

Attitude of Health Personnel↗
PubMed2003

Disturbingly low levels of contraception among women living with hepatitis C.

OBJECTIVE: To describe the prevalence of contraception among a sample of women with hepatitis C (HCV), compare it with contraceptive use among Australian women generally, and look for associations between contraception and sample characteristics. METHOD: Women who self-identified as living with HCV were recruited through a wide range of non-clinical and clinical sites in the Australian Capital Territory (ACT) and Victoria to complete a self-administered questionnaire. RESULTS: Seventy-five per cent of distributed questionnaires were completed and returned. Of the 462 women surveyed, 34% of those aged 18-49 reported using contraceptives; a much lower prevalence than the 67% in the Australian population. Surprisingly, women who reported concerns about transmission to children were no more likely to use contraceptives. Not surprisingly, women who were lesbian or who did not have a current partner were even less likely to use contraceptives. Both employed women and those not on benefits reported significantly higher levels of contraception. Otherwise, contraception did not vary with a range of variables including age, education, injecting drug use status, self-rated health status, experience of HCV symptoms, time since diagnosis, ever having received HCV treatment, or venue at which the participants were recruited. CONCLUSIONS: The low prevalence of contraception among women with HCV is both disturbing and puzzling. IMPLICATIONS: These findings raise several important and hitherto unconsidered issues for the sexual and reproductive health and well-being of women with HCV. These require both further research and urgent attention by service providers.

Adolescent↗