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PubMed1992

Repeat abortion in Denmark.

A study of 50 women undergoing first-time induced abortion and 50 women undergoing second-time induced abortion is reported. Although repeat aborters can not be characterised as a special group of women, it is important that initiatives be taken to reduce the incidence of repeat induced abortion. A suggestion for possible intervention is a thorough post-abortion contraceptive counselling and follow up of women who undergo initial induced abortion. Further general improvement in sex education and use of contraceptive methods is necessary. In this area, avoidance of risk-taking is very important as well as caution during periods of change from one contraceptive method to another. Generally, use of contraceptive methods with a very high effectiveness must be recommended, i.e. oral contraceptives, IUDs, and sterilisation.

Abortion, Habitual↗
PubMed1997

Return of fertility after discontinuation of the once-a-month injectable contraceptive Cyclofem.

The objective of this study was to evaluate the return of fertility in women who used Cyclofem as a contraceptive method during the introductory studies conducted in Brazil, Chile, Colombia, and Peru. From these four cohorts, 101 women were eligible for the study. Thirty-one were not included in the study either because they refused to be interviewed, had initiated another contraceptive method the month after discontinuation, or were unable to be contacted. A total of 70 women were included in the study. Our results showed that the return to fertility rate after the discontinuation of Cyclofem was 1.4 per 100 women at the end of the first month and reached 82.9 at one year. More than 50% were pregnant at 6 months. Fifty-one (94.4%) pregnancies ended in a live birth, two were spontaneous first trimester abortions, and one was a hydatidiform mole. Return of fertility was not related to the woman's age at the time of discontinuation, her weight, or the number of Cyclofem injections. In conclusion, fertility is restored by 1 month following Cyclofem discontinuation. Users and potential users should be counseled regarding the rapid return of fertility after discontinuing this method of contraception.

Adult↗
PubMed2000

New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes.

Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA). As safety information changes, however, checklists can quickly become outdated. Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives. In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods. Based on these criteria, new checklists for COCs and DMPA were developed. This article describes the new checklists and their development. Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements. Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility. These findings indicated the need for a checklist guide. In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use. The article reflects also the resulting updated checklist.

Community Health Services↗
PubMed1981

The effect of a contraceptive vaginal ring and oral contraceptives on the vaginal flora.

Premenopausal women seeking a steroid contraceptive method were allowed to choose between a contraceptive vaginal ring (CVR) containing levonorgestrel and estradiol used in a 3-week in, 1-week out regimen (n=20) and an oral contraceptive (OC) containing levonorgestrel and ethinyl estradiol in a 28-day regimen (n = 10). Cultures from the posterior vaginal fornix were obtained before therapy in both groups and monthly for 6 months for the CVR group and after 1, 3, and 6 months for the OC group. These cultures were streaked on specific media to provide quantitative aerobic and anaerobic, lactobacillus, Candida sp., Gardnerella vaginalis and Neisseria gonorrhoeae counts in micro-organisms per milliliter. A comparison of the number and types of organisms isolated from vaginal cultures obtained initially and at 6 months demonstrated no statistically significant differences in colony counts between CVR and OC users. The results of this study suggest that the use of the CVR is not associated with a greater growth of pathogens than is oral administration of a progestin and estrogen combination.

Adult↗
PubMed1982

The effectiveness of barrier methods of contraception with and without spermicide.

This paper reviews trials of the effectiveness of barrier contraception with and without spermicide, and discusses the advantages and disadvantages of using spermicides with barriers. There is very little evidence to allow comparison of the effectiveness of barriers with and without spermicide. Little or no evidence could be found to support many of the instructions given to users of barrier contraception. The lack of scientific data on this subject has prompted us to recommend research in specific areas. Until the findings of such research are available, the information which has emerged from this review suggests that the recommendations issued to users of barrier contraception should be brought up-to-date.

Contraceptive Devices, Female↗
PubMed1997

Condom and other contraceptive use among a random sample of female adolescents: a snapshot in time.

This study examined the sexual practices of 235 females aged 15 to 19 years and their readiness to use specific contraceptive methods for birth control and sexually transmitted disease (STD) prevention. The investigation was based on the stages-of-change construct from the Transtheoretical Model (Prochaska & DiClemente, 1983, 1984). Results demonstrated that despite the availability of newer contraceptive methods (e.g., Depo-Provera), most sexually active adolescents were least resistant to using condoms and were further along in the stages of change for condom use as compared with other contraceptive methods. Moreover, the females perceived the male condom as an acceptable method for prevention of both pregnancy and STDs. These findings suggest that interventions designed to target consistent and correct condom use may result in better compliance, reducing the number of unintended pregnancies and STD cases among this populations.

Adolescent↗
PubMed1995

New contraceptives in the 1990s.

This article reviews the contraceptive methods levonorgestrel implants and depot medroxyprogesterone acetate. These methods provide effective and safe contraception for adolescents and adults. This review focuses on the use of these contraceptive techniques in the adolescent population, discussing patient selection, side effects, and controversies concerning the methods. Future hormonal contraceptive methods are also discussed.

Adolescent↗
PubMed1980

Experience with the copper 7 intrauterine device in an adolescent population.

A retrospective study was conducted of 120 consecutive patients who received a Cu-7 IUD at the Cincinnati Adolescent Clinic during a four-year period from July, 1974, through June, 1978. Follow-up was obtained in 116 (97%) of the initial patient population. Mean age at initial Cu-7 insertion was 16.8 years; 81% of the patients were nulliparous. An experience of 149.7 women years was accumulated; the pregnancy rate at the conclusion of the study was 2.0/100 women years. Continuation rate was 83% at six months, 70% at 12 months, 49% at 24 months, and 39% at 36 months. Patient expulsion rate was 18% overall, with a total of 17 expulsion events/100 woman years. Subjective satisfaction with the IUD as a contraceptive method was expressed by 72% of these patients. The Cu-7 has proven to be a safe, effective, well-tolerated contraceptive method in the adolescent female.

Adolescent↗
PubMed1976

Cervical gonorrhea in women using different methods of contraception.

Cultures were made from the cervix, rectum, and oropharynx of 2,019 women to determine the prevalence of gonorrhea. For patients of similar race and age, the rates of cervical gonorrhea among users of oral contraceptives (10.6/100) or IUD users (9.5/100) were significantly greater than observed with patients using barrier methods, condom-diaphragm-foam (1.7/100). On the other hand, there were no significant differences in rates of rectal or oral infection by method of contraception. Postpartum patients were found to have similar infection rates at all three sites as a comparable group of nonpuerperas. Recommendations for utilization of barrier methods are made for suitable patients, including those in the immediate puerperium.

Contraception↗
PubMed1996

Depot medroxyprogesterone acetate contraception in women with medical problems.

Since few clinical trials of contraceptive agents are conducted on women with medical problems, use of these agents in these populations is often based more upon theoretical considerations than clinical data. Clinicians must distinguish the risk of estrogen in the combined oral contraceptive from the risk of the progestin-only contraceptive methods. This review compares the risks of pregnancy with the risks of contraceptive methods for patients with chronic hypertension, cardiac disease, thrombotic disorders, diabetes, epilepsy, lupus erythematosus and other medical disorders. For women with certain medical problems, estrogen, but not progestogen, may be contraindicated. For these women, a long-acting progestogen, such as depot medroxyprogesterone acetate (DMPA), may offer distinct advantages.

Cardiovascular Diseases↗
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↗
PubMed1992

Connotative meanings assigned to contraceptive options.

Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.

Adolescent↗
PubMed2003

Combined hormonal versus nonhormonal versus progestin-only contraception in lactation.

BACKGROUND: Contraception for women who are breastfeeding is a public health issue of global importance. Each year over 100 million women make decisions about beginning or resuming contraception after childbirth. These decisions include both the choice of contraceptive method and the time at which its use begins, both of which continue to be debated by experts. Choices of contraception may be limited for lactating women due to concerns about hormonal effects on quality and quantity of milk, passage of hormones to the infant, and infant growth. Ideally, the contraceptive method chosen should not interfere with lactation. Additionally, because the return of menstruation and ovulation can be unpredictable in breastfeeding women, the timing of contraception initiation is important. OBJECTIVES: To determine the effect of combined oral contraceptives and progestin-only contraceptives on lactation. The a priori hypothesis is that combined oral contraception impairs lactation, making it less appropriate than progestin-only or nonhormonal contraception for breastfeeding women. SEARCH STRATEGY: We used PUBMED, POPLINE, EMBASE, LILACS, and Cochrane Controlled Trials Register computer searches, supplemented by review articles and contact with investigators. SELECTION CRITERIA: We sought all randomized controlled trials, reported in any language, that included any form of hormonal contraception compared with another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception could include combined oral or injectable contraceptives, progestin-only oral or injectable contraceptives, hormonal implants, or hormonal intrauterine devices. Study participants included breastfeeding women of any age or parity who desired contraception. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicenter trials. We abstracted data onto data collection forms. Principal outcome measures included quantity of milk; biochemical analysis of milk composition; initiation, maintenance and duration of lactation; infant growth; efficacy of contraceptive method while breastfeeding; and timing of contraception initiation and its effects on lactation. Because the trials did not have uniform interventions, often lacked quantifiable outcomes, and had poor methodological quality, we could not aggregate the data in a meta-analyses. MAIN RESULTS: Seven reports from five randomized controlled trials met our inclusion criteria. Most of the five trials did not specify their method used to generate a random sequence, method of allocation concealment, blinding of treatments, or use of an intention-to-treat analysis. Additionally, high loss to follow-up rates invalidated at least two studies. The findings from two reports comparing oral contraceptives to placebo during lactation were conflicting. Another trial found no inhibitory effects on lactation from progestin-only contraceptives. Finally, the WHO trial found no effect of progestin-only contraceptives on lactation but a decline in breast milk volume from combination contraceptives during lactation. High loss to follow-up rates, however, undermine the credibility of the WHO trial. No significant differences in infant growth or weight appeared in any of the included trials as a result of the use of hormonal contraception during lactation. REVIEWER'S CONCLUSIONS: Evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is limited and of poor quality; results should be interpreted with caution. The existing randomized controlled trials are insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. Evidence is inadequate to make recommendations regarding hormonal contraceptive use for lactating women. At least one properly conducted randomized controlled trial of adequate size is urgently needed to address this question.

Contraceptives, Oral, Combined↗
PubMed2000

[Isotretinoin in childbearing women: compliance with strengthen warnings].

INTRODUCTION: The recommendations for prescription and dispensing of Roaccutane (isotretinoid) were strengthened in 1997 in order to reduce the number of pregnancies exposed to Roaccutane. The aim of this study was to evaluate the incidence of exposed pregnancies since this time and the compliance with the new recommendations. MATERIAL AND METHODS: All pregnancies exposed to Roaccutane reported to French Regional Drug Monitoring Centers, to Laboratoire Roche or to the Information Center for Teratogenic Agents since the publication of these recommendations for prescription were studied (March 1997-December 1998). In addition, compliance with the new recommendations was evaluated by sampling 169 drug prescriptions dispensed at 105 pharmacies in France. RESULTS: Thirty-seven pregnancies were exposed to Roaccutane during the risk period because of failure of contraceptive methods (28 p. 100), contraception incorrectly followed (52 p. 100) or not prescribed (20 p. 100). The incidence of pregnancies exposed to Roaccutane during the risk period evaluated at 0.6/1,000 women of child-bearing age [0.4-0.8] is very close to the incidence reported in the earlier study which prompted the new recommendations. Thirty-three percent of the 169 prescriptions studied did not carry all the legal warnings. Roaccutane was correctly prescribed for only 18 p. 100 of women, i.e. with a contraceptive method as recommended by the French Drugs Monitoring Agency and with full, correct information. Although the most important recommendations had been followed, 12 p. 100 of women were treated with Roaccutane without contraception and 16 p. 100 received a contraceptive method not recommended by the French Drugs Monitoring Agency (in particular Diane). DISCUSSION: The provision of information must be further improved by enforcing the modalities of prescription and dispensing of Roaccutane. However, it appears that there is no way of completely avoiding patient-related failure.

Abnormalities, Drug-Induced↗
PubMed1997

Determinants of contraceptive use among women of reproductive age in Great Britain and Germany. I: Demographic factors.

Multifactorial analyses of data from representative British and German national contraception surveys were used to examine the principal demographic determinants of contraceptive use by women. Contraceptive use appeared to be determined mainly by reference to 'reproductive status' (the combined impact of age, marital status, parity and future child wish). Women who were postponing pregnancies were using oral contraceptives, whereas those who wanted no more children relied more on intrauterine devices or sterilisation. Differences between the countries suggested that the choice of contraceptive method was influenced by health care policy, the organisation of the relevant services and differential provider preferences. The contraceptive method used was also related to having occasional rather than steady sexual partners (more condom use), lower educational level (less oral contraceptive use) and frequent church attendance (greater use of condoms and periodic abstinence). Contraception decisions appeared to follow a fixed pattern, based more on a couple's demographic situation (reproductive status, country, educational level and religious beliefs) than on the characteristics of the contraceptive methods. This resulted in an unnecessarily restricted choice of methods.

Adolescent↗
PubMed1980

Contraceptive practice and tuboovarian abscess.

The hospital and operative records of 318 women with a discharge diagnosis of tuboovarian abscess (TOA) were reviewed to evaluate the possible relationship between contraceptive usage and the occurrence of TOA. A significantly higher (p < 0.10) proportion of the intrauterine contraceptive device (IUD) users had acute pelvic inflammatory disease and a significantly lower proportion (p < 0.10) compared to users of other contraceptive methods were surgically treated. The proportions of women with unilateral and bilateral TOAs were similar, regardless of the contraceptive method used. This was true whether diagnosis was based on physical examination alone or confirmed at operation.

Abscess↗