SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A program model outlining goals and objectives and activities or processes by which these goals will be reached is essential to ensure effective evaluation of a contraceptive program for adolescents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Long-cycle regimens with continuous use of oral contraceptives (OCs) for 3 or 6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints. A representative survey carried out with 1195 German women in different age groups revealed that only 26-35% of the women aged between 15 and 49 years preferred monthly bleeding, while 37-46% wished to never bleed. The reasons for the refusal of regular menstruations were fewer severe menstrual complaints, better hygiene, higher quality of life, and less blood loss. Among the women who preferred regular withdrawal bleeding during the use of OCs, the main reasons were fear of pregnancy, infertility and adverse effects, and that menstruations were natural. Between 32% and 54% of the women would suppress menstruation sporadically and 11-14% for a longer period of time. After continuous treatment with a combination of 30 microg ethinyl estradiol and 2 mg dienogest for 6 months, the majority of women preferred the long-cycle regimen as compared to the conventional OC regimen despite a higher rate of irregular bleeding. Bleeding occurred primarily in first-time users of OC, particularly during the administration of the second OC pack. A survey carried out with German gynecologists revealed that most physicians prescribed extended OC cycles primarily for medical reasons, e.g., dysmenorrhea, hypermenorrhea, endometriosis and premenstrual dysphoric disorder. The gynecologists preferred a regimen with three packs of extended use of OCs.
The continued high prevalence of oral contraceptive (OC) use by young women warrants the careful study of these agents. At present, it appears that the risk of benign breast disease is reduced by use of OCs. This effect seems to be greater for fibrocystic disease than for fibroadenoma. Available information suggests that, as yet, OC use has not had any effect on breast cancer risk. The recent slight rise in breast cancer rates in younger women has not been shown to be due to OC use. The relationship between OCs and breast cancer may not become clear for another 5 to 10 years because of the long latent period of this disease. Meanwhile, for reasons presented, it would seem wise not to prescribe OCs for women with a history of benign breast disease and to withdraw them from women who develop these conditions.
Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.
Myths and misperceptions continue to influence women's opinions about oral contraceptives (OC), despite the immense body of evidence regarding OC safety and efficacy. Patient opinions about OC failure rates and health risks are often far from proven fact, and the health benefits of OC are too often unrecognized. Because successful OC use requires an informed patient, effective communication between clinicians and their patients is needed to correct misinformation, relieve unnecessary fears, and increase OC use. A variety of interactive counseling skills and attitudes can improve the process of patient counseling; they are especially crucial for adolescents, who may be reluctant or unable to easily articulate their concerns. Counseling messages can be geared specifically to the interests and concerns of particular age groups: adolescents, young adults, and perimenopausal women. With thoughtful planning and involvement of all members of the healthcare team, clinicians can create time and opportunities for the provision of consistent, appropriate counseling to all candidates for OC use.
This study analyzes longitudinal data from Matlab, Bangladesh, to examine the impact of child mortality on subsequent contraceptive acceptance and continuation. The strong negative impact is found to attenuate with family size, indicating a "replacement effect". An "insurance effect" is observed as contraceptive acceptance and continuation were negatively associated with the number of previous deaths of children. Couples seem to find contraceptive use acceptable if the child who dies is one of a large family. Potentially, contraceptive use could be acceptable for spacing after a child in a small family dies. Family planning programs can help to reduce fertility and maternal and child health risks substantially by supplying appropriate methods to those couples who have experienced a young child's death; to be most effective, methods should be supplied immediately after the child's death.
In December 1990, the Food and Drug Administration approved Norplant (Wyeth-Ayerst, Radnor, PA) for general US use. This approval comes during a time period when the number of contraceptors relying on sterilization has risen, echoing known dissatisfaction with other reversible methods. During the past year, data have been presented that refute concern that Norplant may be an abortifacient. Continued estradiol production with development of follicles and ovulation in regularly menstruating women was documented. Ovulatory dysfunction among Norplant users, despite follicular development, was also detailed. Changes in carbohydrate metabolism were confirmed to be clinically insignificant. International development of biodegradable and non-biodegradable implants and 1, 3, or 6 months injectables continues. These injectable and implantable contraceptives promise diversity in contraceptive options to match diversity in contraceptive need and life style.
BACKGROUND: Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. METHODS: We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum. RESULTS: Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use. CONCLUSIONS: The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.
Explore the source record for details and available documents.
The perimenopause is a stage of life when a woman has low fertility but still requires contraception. It is also a peak age for menstrual dysfunction and a time when menopausal symptoms may commence. All these factors impact on contraceptive choice. Combined oral contraception can be continued until the age of 50 years in women who are low risk and do not smoke. Progestogen-only methods have advantages for women who have risk factors for cardiovascular disease. An intrauterine device may exacerbate menstrual problems at this stage but the levonorgestrel releasing intrauterine system is highly effective in controlling perimenopausal menstrual dysfunction. Women should receive accurate individualised advice on how the risks and benefits of contraceptive methods relate to them and on when contraception can be safely discontinued. Hormone replacement therapy is not reliably contraceptive and women should be advised to continue with a contraceptive method until they have reached natural sterility.
Our knowledge about the safety, the incidence of side effects, and the effectiveness of contraceptive methods for women in premenopause, or during the last decade of their reproductive life, has not been a primary interest for research and development in fertility control. The main purpose of trials for the evaluation of new contraceptive methods is to test their effectiveness, and therefore only women below 38 years of age are accepted. Furthermore, when new methods are being tested, only healthy women are accepted, and those having health problems of almost any kind are excluded. Therefore our knowledge about the contraceptive methods in women over 40 years of age is scanty and comes from trials with a long-lasting follow-up on healthy women who can use the method without problems until they are 45 or reach menopause. We have very limited reported information on the use of contraceptives by women who have cardiovascular disease, diabetes, liver problems, etc. Therefore the main body of experience in this review comes from healthy women between 35 and 44. On the other hand, one should remember that these women have a high motivation to use contraceptive methods and therefore the continuation rate in the trials is high. This compensates for the relatively small number of acceptors by giving more women-years in follow-up. Continuation rate and the proper use of methods are directly correlated to increase in age, socioeconomical status, and to education of users. Highly educated women in this age group have very low failure rate with almost any method.
OBJECTIVE: To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults. DESIGN: We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993. MATERIAL AND METHODS: The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined. RESULTS: Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant. CONCLUSION: These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.