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PubMed2003

Attitudes and knowledge about continuous oral contraceptive pill use in military women.

OBJECTIVE: The goal of this study was to determine attitudes toward oral contraceptive pill (OCP)-induced amenorrhea among U.S. Army women. METHODS: A volunteer sample (N = 154) of Army Active Duty, Reserve, and National Guard women completed an anonymous survey. RESULTS: Desire for temporary amenorrhea was high with 86% (+/- 6%, 95% confidence interval [CI]) and 83% (+/-6%, 95% CI) desiring amenorrhea during field training and deployments, respectively. Fifty-four percent were unaware that OCPs can induce amenorrhea; only 7% (+/-4%, 95% CI) have used this practice during deployment. If made available with education, 49% (+/-8%, 95% CI) would use this practice. Logistic burdens of menstruation were associated with higher rates of desirability for OCP use with soldiers desiring OCPs rating their inconveniences significantly higher than those who did not desire OCPs (p < 0.05). CONCLUSION: Although a significant number of soldiers desire OCP-induced amenorrhea, a large deficit in knowledge exists. Routine education as an Army-wide standard is warranted.

Age Distribution↗
PubMed1998

Effect of the British warning on contraceptive use in the General Medical Service in Ireland.

In October 1995 the UK Committee of Safety of Medicine (CSM) issued a warning about the safety (thromboembolic disease) of the third generation oral contraceptive steroids (OCS) recommending a switch to older agents except where women were intolerant of first and second generation OCS. Advice by the Irish regulatory authority (Irish Medicines Board) did not recommend such a switch. This pill scare lead to some UK users stopping OCS mid-cycle and a rise subsequently in abortions and pregnancies was noted. To determine whether local or UK advice was followed we obtained data from the General Medical Service (GMS) Scheme on the use of contraceptive steroids prescribed before and after the CSM's warning. The results show a clear shift from usage of the third generation OCS to the second generation OCS and norgestimate-containing OCS. We have also noted a marked fall in the overall use of the combined OCS, a trend that was noted in the U.K. It is clear that prescribers and pill users were influenced more by advice from the UK than by Irish regulatory authority. There is now a centralised European mechanism to licence drugs in the European Union (EU). We need to develop an EU perspective to issues of drug safety, as constituent nations are no longer isolated islands.

Adolescent↗
PubMed1998

Elevated serum prolactin level with high-dose estrogen contraceptive pills.

BACKGROUND AND OBJECTIVES: There are currently groups of women using high-dose estrogen contraceptive pills, especially in the developing countries. The aim of this study was to determine the correlation between the duration of contraceptive pill intake, the dose of steroid contained in the contraceptive pills and the incidence and degree of serum prolactin level elevation in those women. STUDY DESIGN: This study was conducted in 100 contraceptive pill users. Women were randomly selected for this study with an age range from 19 to 35 years and duration of contraceptive pill intake from 6 to 120 months. Cases were classified into two groups. The first group (50 cases) were taking high-dose estrogen pills (50 micrograms) and the second group (50 cases) were taking low-dose estrogen pills (30 micrograms). RESULTS: The results of the present study showed that there was a significant elevation in serum prolactin level in both groups, with a more significant elevation in the high-dose pill users. CONCLUSIONS: There is a positive relationship between serum prolactin level and the duration of pill intake and their steroid content, and this relationship is not related to the age and parity of the women. The groups of women studied are scheduled for follow-up to determine if there is any future drawback which results as a consequence of the developed hyperprolactinemia. Prolactin determination should be considered for all women prior to pill intake. This determination of serum prolactin level prior to pill use will be useful in the evaluation of the future relationship between the estrogen content of the pills and the later development of hyperprolactinemia.

Adult↗
PubMed2004

Use of oral contraceptives and hormone replacement therapy in the WHO MONICA project.

AIMS: To compare menopausal age and the use of oral contraceptives (OC) and hormonal replacement therapy (HRT) between the 32 populations of the WHO MONICA Project, representing 20 different countries. METHODS: Using a uniform protocol, age at menopause and the use of OC and HRT was recorded in a random sample of 25-64 year-old women attending the final MONICA population cardiovascular risk factor survey between 1989 and 1997. A total of 39,120 women were included. RESULTS: There were wide variations between the populations in the use of OC and HRT. The use of OC varied between 0 and 52% in pre-menopausal women aged 35-44 years, Central and East Europe and North America having the lowest and West Europe and Australasia the highest prevalence rates. Among post-menopausal women between 45 and 64 years, the prevalence of HRT use varied from 0 to 42%. In general, the use of HRT was high in Western and Northern Europe, North America and Australasia and low in Central, Eastern and Southern Europe and China. With the exception of Canada (45 years), the mean age at menopause differed only little (ranging from 48 to 50 years) between the populations. CONCLUSION: The use of OC and HRT varies markedly between populations, in general following a regional pattern. Whereas, the prevalence rates are mostly similar within a country, there are remarkable differences even between neighbouring countries, reflecting nation-specific medical practice and public attitudes that are not necessarily based on scientific evidence.

Adult↗
PubMed1998

Use of oral contraceptives and risk of breast cancer in young women.

Many studies have shown that oral contraceptive (OC) use increases a young woman's risk of breast cancer, although some studies suggest that the risk may be limited to recent use. The objective of this study was to determine what particular aspects of OC use could be important for breast cancer development at an early age in the cohort of women who had the opportunity to use OCs all of their reproductive life. The cases were first diagnosed with breast cancer at age 40 or younger between 1983 and 1988, and identified by the Los Angeles County Cancer Surveillance Program. Control subjects were individually matched to participating cases on birth date (within 36 months), race (white), parity (nulliparous versus parous), and neighborhood of residence. Detailed OC histories were obtained during in-person interviews with subjects. In general the risk estimates were small, and not statistically significant. Compared to no use, having used OCs for 12 years or more was associated with a modest non-significant elevated breast cancer risk with an odds ratio (OR) of 1.4 (95% confidence interval (CI) = 0.8-2.4). Long-term (12 years or more) users of high-dose estrogen pills had a non-significant 60% higher breast cancer risk than never users (CI = 0.9-3.2). Early use was associated with slightly higher ORs among young women (age < or =35), and among parous women. Recent use was associated with somewhat higher ORs among parous women and women above age 36. Analyses by stage, body weight, and family history yielded similar results. This study is consistent with a modest effect of early OC use on breast cancer risk in young women.

Adult↗
PubMed1994

Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery.

A longitudinal prospective trial was carried out on 146 patients to evaluate which factors can have an effect on postoperative recovery after extraction of impacted third molars or wisdom teeth. The following factors were considered: (1) age, (2) sex, (3) smoking habits, (4) use of the birth control pill, (5) previous history of pericoronitis, (6) degree of difficulty of the extraction, (7) expertise of the surgeon, (8) length of surgery, and (9) antibiotic prophylaxis. The following results were obtained and statistically significant differences were noted with respect to the pain in the context of (1) sex-males noted more pain on the 1st and 3rd days (p < 0.05) compared with females; (2) expertise of the surgeon--patients treated by surgeons with considerable or average expertise reported less pain on the first and third days (p < 0.05) compared with patients treated by surgeons with little expertise; and (3) age--a direct correlation was noted between age and pain (p < 0.05).

Adult↗
PubMed1982

Sex of offspring of women using oral contraceptives, rhythm, and other methods of birth control around the time of conception.

Sex ratios were studied in a cohort of 33,205 newborns whose mothers had been questioned in early pregnancy about contraceptive use around the time of conception., The proportion of males was 0.517 (95% confidence limits [CL], 0.512 to 0.522). In the 9279 offspring of women who had used oral contraceptives (OC) in the 5 months prior to conception the sex ratio was 0.517 (0.507 to 0.527). There are sufficient numbers available for study for us to be 95% certain that OC causes no shift in sex ratio of 1% or more. Women who conceived within 2 months of stopping the pill had a small excess of males (0.528; 95% CL, 0.510 to 0.546), but this excess was probably due to chance. OC failures were followed by a raised sex ratio in the offspring (0.543; 95% CL, 0.509 to 0.577), and this excess of males was observed consistently in subgroups of maternal age, parity, race, and education. Failures of rhythm contraception were also associated with a consistent excess of male births (0.567; 95% CL, 0.514 to 0.620). No changes were observed after failures of IUDs, barrier, or chemical methods.

Adult↗
PubMed2002

Risk factors for progression of squamous cell cervical carcinoma in-situ to invasive cervical cancer: results of a multinational study.

OBJECTIVE: Human papillomaviruses (HPVs) are probably necessary causes of cervical carcinoma, but few infected women develop invasive cervical cancer, suggesting a role for cofactors. The purpose of this study was to identify cofactors associated with progression of carcinoma in-situ to invasion. METHODS: Data from in-person interviews of women included in a multinational, hospital-based case-control study of in-situ and invasive squamous cell cervical carcinoma were analyzed. In-situ cases and controls were compared to identify risk factors for carcinoma in-situ, and invasive and in-situ cases were compared to identify risk factors for progression to invasive disease. RESULTS: Risk of invasion was decreased in women with a history of cytologic screening, and in relation to other variables that likely represent enhanced opportunities for screening or clinical evaluation of symptomatic disease. No other risk or protective factors for progression were convincingly demonstrated. Risk of progression was not associated with multiple incidences of promiscuous sexual behavior, or use of steroid contraceptives, although there was a possible association with high parity. CONCLUSIONS: Possible cofactors that have been considered in this study alter the carcinogenicity of an HPV infection primarily prior to the development of cervical carcinoma in-situ. Women with a history of this condition need not avoid use of steroid contraceptives.

Adult↗
PubMed1989

[Immunohistochemical receptor findings in the endometrium and therapeutic consequences in endogenous and exogenous functional disorders and cancer].

We studied immunohistochemically cryostat sections made from fresh endometrial tissue, immediately frozen after removal (86 hysterectomy specimens, 6 curettages) for their content of oestrogen receptors (ER) using the ER-ICA assay. Routine histological sections were prepared from parallel specimens of the endometria for determining endometrial functions. The evaluation of the immunohistiological preparations showed that the ER content in the endometrium was closely related to the endogenous hormone stimulation. A further refinement and differentiation of that relationship became possible and correlated well with the various forms of follicle and corpus-luteum insufficiencies. The results indicated that it is now possible to recommend therapy of functional disorders of the endometrium, esp. in sterility cases, without need or knowledge of serum hormone levels. As the endometrial glandular proliferation increases, the density of the ER becomes more intense. In contrast, under therapy with predominantly gestagenic preparations or after these are discontinued, the ER are decreased more than found in normal glands at that degree of proliferation. Whereas the atrophic endometria of old age contained greatly diminished but still detectable ER, no ER could be found in endometrial atrophy induced by oral contraceptives. Carcinomatous endometria revealed a heterogeneous distribution of ER. The better the tumour cells were differentiated, the greater was the density of the ER. By contrast, the carcinomas derived from metaplastic Müllerian epithelium contained few or no ER. This difference is of practical importance, since an adjuvant anti-oestrogen therapy seems of value only with ER-positive carcinomas. The immunohistochemical determination of ER is more exact than the biochemical determination, for each single cell can be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1984

Risk factors for pathologically confirmed benign breast disease.

Between November 1981 and March 1983, data were collected to evaluate risk factors for benign breast lesions in a case-control study based on 288 women with histologically proven benign breast disease, admitted for biopsy to the Tumor Institute of Milan, and 285 age-matched controls. Questions were asked about menstrual and reproductive characteristics, marital status, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. Nulliparity or low parity, late age at first birth, and late menopause were associated with an increased risk of benign breast disease. The elevated risk associated with late age at first birth was not accounted for by parity. Early age at menarche was associated with an increased risk, but the estimate was not statistically significant. The data do not suggest that the use of oral contraceptives or other female hormones (such as estrogen replacement therapy) is related to the risk of benign breast disease. Risk was apparently lower, however, among current and long-term oral contraceptive users. There was no evidence of a trend with reference to body mass index. The present data indicate a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease, not only directly, by showing a relationship with parity, age at first birth, and age at menopause, but also indirectly, by failing to produce evidence that greater weight or the use of oral contraceptives has a protective effect.

Adolescent↗
PubMed1995

Intravasal injection of formed-in-place medical grade silicone rubber for vas occlusion.

This paper describes two consecutive studies: a volume study and an efficacy study. The volume study determined the appropriated volume of Medical Grade Silicone Rubber (MSR) needed to achieve complete occlusion of the vas deferens. This was done by in-vitro testing of 130 human vas specimens containing plugs of MSR formed in vivo. The volume of MSR needed to occlude the vas was 0.1531 +/- 0.0059 ml injected by five to six turns of the applicator handwheel. There was a correlation between MSR volume, weight, and the number of turns of the applicator handwheel. An influence of body height upon the volume and weight of the MSR was also observed. An oval shaped clamp (15 mm long) was more effective in producing secure vas occlusion than was a round clamp (10 mm long). The mean outer diameter of the vas specimens was 1.80 +/0 0.15 mm, and the mean maximum dilated inner diameter was 0.93 +/- 0.11 mm. The efficacy study was a clinical trial to compare MSR was occlusion (using an oval 15 mm clamp and the appropriate volume derived from the volume study, n = 58) with no-scalpel vasectomy as the standard procedure (n = 64). The azoospermia rate following MSR vas occlusion was not significantly different from that following no-scalpel vasectomy, and was achieved in 3-6 months.

Biocompatible Materials↗
PubMed1981

Oral contraception and myocardial infarction revisited: the effects of new preparations and prescribing patterns.

All deaths from myocardial infarction occurring during 1978 in women aged 15-44 years in England and Wales have been investigated. Using a case-control approach, oral contraceptives were found to be associated with an approximately two-fold increase in risk of this condition, but the effect was apparent only in women with no known risk factors for ischaemic heart disease. Preparations containing 30 micrograms or less oestrogen were associated with the same risk as those containing 50 micrograms oestrogen, but this could be due to the fact that preparations containing less oestrogen tend to contain higher doses of progestogens. Oral contraceptives appear no longer to be prescribed for women with recognised coronary risk factors and this improved prescribing practice has probably resulted in a substantial decrease in mortality attributable to oral contraceptive use.

Adolescent↗
PubMedDate not supplied

Contraception and adolescent pregnancy.

To identify reasons for increasing numbers of pregnant adolescents, questionnaires were distributed to teenagers with unplanned pregnancies to determine the level of their knowledge of contraception. Findings revealed that 94% of the subjects had an adequate knowledge of availability, while only 43% had an adequate overall knowledge of contraception. Subjects reported many misconceptions about contraceptives and a general lack of motivation concerning contraceptive use.

Adolescent↗
PubMed1978

Changes in the incidence of acute gonococcal and nongonococcal salpingitis. A five-year study from an urban area of central Sweden.

The incidence of acute gonococcal and nongonococcal salpingitis for a five-year-period (1970--74) was studied retrospectively in an urban area of central Sweden. The investigation was undertaken to see if the reported decrease of gonorrhoea in Sweden had been followed by a change in the incidence of gonococcal salpingitis--the most common complication of gonorrhoea. The study showed that the relative incidence of acute gonococcal salpingitis had decreased even more than urogenital gonorrhoea and these findings thus indicate a real decrease of gonorrhoea. At the same time there were more patients with nongonococcal salpingitis. During the period of the study the gonococcal complement-fixation test (GCFT) gave positive results in 40% to 80% of the patients with gonococcal salpingitis. The yield with this test was only 4% in patients with nongonococcal salpingitis during 1970 but it increased successively and was 23% in 1974. This increase was statistically highly significant (P less than 0.001).

Acute Disease↗
PubMedDate not supplied

Cerebral thromboembolism among young women and men in Denmark 1977-1982.

In the period 1977-1982, the Danish National Patient Register recorded 1000 cases of cerebral thromboembolic attacks among women 15-44 years of age, and 971 cases among men of the same age. Cerebral infarction accounted for 70% of cases and transient ischemic attacks (TIA) for the remaining 30%. By analysing this material we found an average age-adjusted incidence rate of cerebral thromboembolism of 14.4/100.000 among men and 15.5/100.000 among women. The incidence rates rose rapidly with increasing age. Women aged 15-34 had significantly higher incidence rates of brain infarction and TIA compared to those of men of the same age. This was reversed in the age group 35-44. The magnitude of the ratio between the female and the male mean incidence rates by increasing age corresponded exactly to the age distribution of the use of oral contraceptives in Denmark. The relative risk for developing cerebral thromboembolism among users of oral contraceptives was estimated to be 3.2-6.5. The mortality in male patients with brain infarction was 3.3% and in females 1.7%. The mean duration of stay in hospital was 8.8 days for TIA and about 26 days for cerebral infarction. Sixteen percent of men and 13.6% of women had hypertension during their stay.

Adolescent↗