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A healthy woman aged 21 years who used the oral contraceptive Trigynon became pregnant while being treated with Minocin (minocycline; 100 mg per day) for acne conglobata. While the risk of use of antibiotics such as this one reducing the efficacy of oral contraceptives is small, patients should nevertheless be informed that the risk exists.
Ectopic pregnancy (EP) admissions at The Johns Hopkins Hospital were reviewed for 160 patients admitted from 1970 to 1974 and 253 patients from 1980 to 1984. Over the decade, average annual admissions for EP increased by 64%, and a higher proportion of cases in 1980 to 1984 were unmarried women with no insurance coverage. There were significant increases in cases with a history of sexually transmitted diseases (from 19.1% to 31.6%) and in recurrent EPs (7.6% to 19.0%) but declines in EP associated with contraceptive failures. Newer diagnostic techniques such as quantitative serum human chorionic gonadotropin assays, pelvic ultrasound, and laparoscopy were more frequently used in the 1980 to 1984 period, resulting in less severe morbidity on admission, more conservative surgical management, and reduced length of hospitalization. Thus, although admissions for EP have increased, the severity of illness has been reduced by earlier diagnosis and more conservative management.
Management of oral contraception requires an understanding of the relationships between the method's effectiveness, noncontraceptive benefits, and hormonal adverse effects. The new multiphasic combinations or OCs containing 35 micrograms of ethinyl estradiol and 0.5-1.0 mg of norethindrone or equivalent result in a maximum combination of efficacy and safety for the patient with minimal annoying problems for the patient and the prescriber. Patient education regarding early warning symptoms of adverse effects, breakthrough bleeding, and lack of withdrawal bleeding adds an additional margin of safety and reduces patient questions and uncertainties.
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One hundred and sixty eight consecutive women accepting copper T (CuT) intrauterine contraceptive device in the post-puerperal period were studied. Out of them, 63 could be followed after 6 weeks of insertion and 65 after 6 months of insertion. The risk of heavy bleeding, pain in abdomen etc. were no greater than those usually found when interval CuT insertion is carried out. There was no case of uterine perforation leading to migration of CuT. But the expulsion rate was found to be high i.e. 16.4%. CuT is a very useful post-puerperal contraceptive method and should be given more importance in MCH programme.
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The paper reports a series of 1,000 consecutive vasectomies, mostly self referrals, performed at a family planning clinic. Comprehensive counseling was a mandatory prerequisite, the average time spent considering vasectomy prior to counseling was 22 months. The couples characteristics were as follows: age 30-39 years, married 11.3 years, with 3.4 children, upper social class preponderance. To minimise the risk of recanalisation (0.2%), 20 mm of vas deferens was resected. In the early part of the series, inflammatory tissue reaction due to slow absorption of synthetic suture posed a minor problem which was subsequently eliminated by use of a soft gut variety. The majority (99%) was pleased with the procedure and did not suffer complications. One per cent experienced some psycho-sexual problems such as decreased libido, ejaculatory problems, depression. Based on data collected from other centres we estimate that 3,303 sterilizations were performed in Ireland in 1986 with a male:female ratio of 3.2.
IUDs have been used in Singapore since the mid 1960's but acceptance of this contraceptive method has fluctuated widely as a result of misconceptions regarding possible complications. The current generation of copper bearing devices have pregnancy rates below 1 per 100 women per year and this rate falls further with continued use. New developments which hold promise include a device releasing 20 mcg levonorgestrel per day and a copper device without a plastic frame which may reduce menstrual blood loss and dysmenorrhoea. In addition to the well established contra-indications to use, a past history of pelvic inflammatory disease or ectopic pregnancy, promiscuity, nulliparity and age less than 25 are now considered relative contraindications.
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