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PubMed1978

Evaluation of a combined oestrogen-progestogen injectable contraceptive.

A combined injection of 50 mg medroxyprogesterone acetate and 10 mg oestradiol cypionate (Cyclo-Provera; Upjohn) was administered monthly for periods ranging from 1 to 18 months, to 120 Black women of reproductive age. No major side-effects were noted, no pregnancies occurred in the 575 cycles studies, and the pattern of regular menstrual bleeding was acceptable. Amenorrhoea occurred in 15,8% of patients but only 2,5% requested a change of treatment. The incidence of amenorrhoea diminished with continued use. This contraceptive regimen appears to be a useful addition to the methods presently available. Certain aspects merit further study.

Adolescent↗
PubMed1985

Barrier contraception in the teenager: a comparison of four methods in adolescent girls.

The use-effectiveness and continuation rates of 4 methods of contraception were studied during a 2 year follow-up period in a group of 405 teenage girls. Results were compared in 2 groups of adolescents, 1 of highly motivated, high socioeconomic status girls (A) and 1 of poorly motivated, low socioeconomic status adolescent clinic patients (B). The method of contraception was selected by the girls, who were instructed in their proper use. Results showed good rates of continuation among girls of the 1st group as compared to those of the 2nd group. Pregnancy rates after 24 months of use, as calculated by Pearl's formula, was 3.6 and 5.4 respectively with the use of a condom, and 5.8 and 10.8 when the diaphragm was used. When using vaginal foam alone, the rates were 4.2 and 12.3 and with the rhythm method, 8.5 and 13.1. The foam-alone method was unpopular in both groups. No serious side effects or complications were recorded. The study demostrated a reasonable acceptability and use-effectiveness for barrier contraceptives. It is suggested that these harmless and complication-free methods, especially the condom and diaphragm, may be reasonable alternatives for the more modern methods in teens of all socioeconomic strata; an effort must be made to educate and instruct the poorly motivated and encourage them to present themselves for regular follow-up.

Adolescent↗
PubMed2005

Demographic analysis of post-abortive and interval-administered hormonal contraceptive methods.

OBJECTIVE: To compare, using method type and application time, the demographic characteristics of women using hormonal contraceptive methods administered after abortion or during the interval period with those of intrauterine device (IUD) users. METHODS: The demographic characteristics of women to whom oral contraception (OC), monthly injection, depot medroxyprogesterone acetate (DMPA), or IUD were administered in the post-abortive and interval periods between January 1998 and September 2001 in our clinic, were evaluated with the help of a registration system based on the Microsoft Access software used in our clinic. Demographic characteristics recorded were: age, reproductive expectation, previous contraceptive method, education level, number of live children, number of induced and spontaneous abortuses. RESULTS: A total of 10 500 women were included in the study. Of these, 6601 women had taken a contraceptive method during the interval period, and 3899 women had taken a contraceptive method post-abortion. Only 4.6% of the cases were younger than 20 years, 48.3% were between 21 and 30 years, 37.2% were between 31 and 40 years and 9.9% were 41 years old or over. The DMPA-administered group contained the highest number of women > or = 41 years when compared to other groups (22.8%). In reproductive expectations, 65.8% of the cases wanted no more children; 1.3% wanted to have a baby within a 2-year period whereas 23.7% wanted a child after 2 years. The proportion of women wanting no more children was greatest in the DMPA-administered group (77.3%). No previous use of contraceptive methods was reported by 20.7% of women; 27% were using coitus interruptus. The education level of the women was as follows: 10% had no education, 58.3% had education to primary school level, 23.2% to secondary-high-school level and 2.1% to university level. The group of women who chose OC as their contraceptive method contained the highest proportion of university graduates (6.5%). Only 6.26% of the women had no children. The proportion of women in the DMPA-use group with three or more children was higher compared to that in other groups (33.2%). CONCLUSION: The evaluation of demographic characteristics plays an important role in counseling, and in the efficacy and continued use of contraceptive methods.

Abortion, Spontaneous↗
PubMed2004

[Diagnosis and treatment of endometriosis in adolescents].

OBJECTIVE: To discuss the clinical feature, diagnosis and treatment options of adolescent endometriosis. METHODS: The records of adolescent patients with endometriosis (11-20 years old) who were admitted to First, Second and Third Affiliated Hospital of Zhongshan University and Guangdong Provincial People's Hospital between 1990 and 2003 were retrospectively reviewed. RESULTS: Forty-three patients were diagnosed as endometriosis either by laparotomy or laparoscopy. The chief symptoms leading to the diagnosis were palpable pelvic mass (18/43), dysmenorrhea (15/43), chronic pelvic mass (10/43) and acute pelvic pain (4/43). The majority of patients (53%) presented with the revised AFS-r classification stage III, 8 cases (19%) presented with stage I, 3 cases (7%) with stage II and 9 cases (21%) with stage IV. Nine cases (21%) had complicated genital tract abnormalities. Conservative operations, including salpingo-oophorectomy ins cases, ovarian cystectomy in 31 cases and laparoscopic vaporization in 8 cases, were performed. Surgeries were followed by hormonal suppression using oral contraceptives in a continuous or cyclic manner. CONCLUSIONS: Adolescent endometriosis may occur around 4.6 years after menarche. The chief symptoms are palpable pelvic mass and dysmenorrhea. The treatment of endometriosis in adolescence does not differ principally from that in adult women. In the treatment of endometriosis and for the prevention of recurrence, it is recommended to give 3-6 months of oral contraceptives.

Adolescent↗
PubMed1999

From abortion to contraception in Europe.

OBJECTIVES: This review summarizes abortion statistics, mainly in Europe and primarily in Eastern Europe. The reasons for unwanted pregnancies and consequent abortions are analyzed. Recommendations are proposed to achieve a shift from abortion to contraception in fertility regulation. METHODS: The relevant literature and the results of the data collected by the author in 16 Eastern European countries by means of a questionnaire are reviewed. CONCLUSIONS: The need and the possibilities for better future perspectives are outlined in the conclusions of The Szeged Declaration. The major problems identified were the low level or lack of training of professionals, deficiencies in the knowledge of current family planning methods among professionals, consumers, policy makers and media representatives, the lack of supplies of modern contraceptives to meet the needs of the population, the lack of sex education in schools and the high level of induced abortions. In the majority of the countries in the Eastern European region, there is a need for the establishment of a system for the delivery of high-quality family planning services. This imposes a requirement for the establishment of a system for the continuous supply of contraceptives, through national family planning programs, by governmental and/or nongovernmental organizations. To increase contraceptive use, countries in this region should consider the establishment of extensive educational programs on current family planning methods and other aspects of reproductive health for their health professionals, consumers and representatives of the media. Sex education in schools should be promoted. Governments should be encouraged to invest more in setting up and running family planning services and programs.

Abortion, Legal↗
PubMedDate not supplied

Early experience with the contraceptive use of depot medroxyprogesterone acetate in an inner-city clinic population.

There are few data on the experience of American women with the injectable depot medroxyprogesterone acetate (DMPA) since its recent approval by the Food and Drug Administration for contraceptive use in the United States. An exploratory study was conducted using chart reviews and telephone interviews of 261 women who initiated DMPA use between December 1992 and June 1994 at either a hospital-based (48%) or community-based (49%) clinic in New York City. Most DMPA users were single (70%), had had at least one birth (88%), had had at least one abortion (67%) and had ever practiced contraception (75% of those with available data). Life-table DMPA continuation rates were 63% at six months and 42% at 12 months and were not affected by the users' age, marital status, pregnancy history, clinic site or proximity of residence to the clinic. Among adults, the risk of DMPA discontinuation was highest during the three-month period following the second injection, while among adolescents, this risk increased throughout the duration of use. The most commonly reported reasons for method discontinuation were side effects, primarily menstrual irregularities (30%) and weight gain (24%).

Adolescent↗
PubMedDate not supplied

Family planning clinic services in the United States: patterns and trends in the late 1990s.

CONTEXT: Publicly funded family planning clinics are a vital source of contraceptive and reproductive health care for millions of U.S. women. It is important periodically to assess the number and type of clinics and the number of contraceptive clients they serve. METHODS: Service data were requested for agencies and clinics providing publicly funded family planning services in the United States in 1997. The numbers of agencies, clinics and female contraceptive clients were tabulated according to various characteristics and were compared with similar data for 1994. Finally, county data were tabulated according to the presence of family planning clinics and private physicians likely to provide family planning care and according to the number of female contraceptive clients served compared with the number of women needing publicly funded care. RESULTS: In 1997, 3,117 agencies offered publicly funded contraceptive services at 7,206 clinic sites. Forty percent of clinics were run by health departments, 21% by community health centers, 13% by Planned Parenthood affiliates and 26% by hospitals or other agencies. Overall, 59% of clinics received Title X funding. Agencies operated an average of 2.3 clinics, and clinics served an average of 910 contraceptive clients per year. Altogether, clinics provided contraceptive services to 6.6 million women-approximately two of every five women estimated to need publicly funded contraceptive care. The total number of providers and the total number of women served remained stable between 1994 and 1997; at the local level, however, clinic turnover was high. Some 85% of all US counties had one or more publicly funded family planning clinics; 36% had one or more clinics, but no private obstetrician-gynecologist. CONCLUSIONS: Publicly funded family planning clinics are distributed widely throughout the United States and continue to provide contraceptive care to millions of US women. Clinics are sometimes the only source of specialized family planning care available to women in rural counties. However, the high rate of clinic tumover and the lack of significant growth in clinic numbers suggest that limited funding and rising costs have hindered the further expansion and outreach of the clinic network to new geographic areas and hard-to-reach populations.

Adolescent↗
PubMed1999

Cycle control with oral contraceptives: A review of the literature.

Comparing the degree of cycle control provided by various oral contraceptives is problematic. The inherent limitations, small demonstrated differences, and differing methods of data presentation characteristic of these trials support the conclusion that it is almost impossible to compare the bleeding patterns of one preparation with those of another. Chlamydial infection, smoking, and inconsistency of use are factors that have significant effects on rates of spotting and breakthrough bleeding. Clinicians must alert patients to the possibility of intermenstrual bleeding and educate them with regard to the importance of continued, consistent oral contraceptive use to minimize those problems among pill users in their practices.

Chlamydia Infections↗
PubMedDate not supplied

Portal vein thrombosis associated with prolonged ingestion of oral contraceptive steroids.

The case is described of a 38 year old woman who developed severe right upper quadrant abdominal pain that was associated with partial portal vein occlusion, as confirmed by flow Doppler ultrasonography and dynamic contrast computed tomography. The patient was a cigarette smoker and had taken combined oestrogen/progestagen oral contraceptive steroids (OCS) continuously for 24 years. There were no other risk factors for portal vein thrombosis or for thromboembolic disease. Following anticoagulant therapy and discontinuation of OCS complete recovery occurred. The case is reported to draw attention to portal vein thrombosis as an extremely rare complication of OCS.

Adult↗
PubMed2000

[Long-term effects of low-dose combined norethisterone and combined 18-metayl-norethisterone on lipid metabolism in healthy women].

OBJECTIVE: To assess the long-term effects of combined oral contraceptive pills use on the mean of serum TG, TC, HDL-C, LDL-C, ApoA1, ApoB and Lp(a). METHODS: The study was carried out in 446 women grouped as combined norethisterone containing ethinylestradiol (EE) 35 micrograms and norethisterone 625 micrograms; combined 18-metayl-norethisterone (norgestrel) containing EE 30 micrograms and 18-metayl-norethisterone 300 micrograms for using 5-25 years, and control subjects wearing IUD for the corresponding period. The three groups were similar in age, body mass index (BMI), continued period of contraceptives use and income. RESULTS: The data showed that changes of varying degree of lipid and lipoprotein parameters were obvious in women of long-term taking low-dose combined norethisterone and norgestrel, compared with the control. The mean of TG, HDL-C, ApoA1 were significantly increased simultaneously (P < 0.05, P < 0.01), indicated multiple effects of two low-dose Chinese COCs on lipid lipoprotein parameters. In addition, A significant increase (P < 0.05) in Lp(a), an independent risk factor for cardiovascular disease, was found in norgestrel group. Further more, the results of stratified analysis to duration of contraceptives use showed that the mean of TC, LDL-C, in the combined norethisterone use less than 15 years, after the adjusting for age, were significantly lower (P < 0.05, P < 0.01) and the ratio of LDL-C/HDL-C was improved (P < 0.05), compared with the Norgestrel; at the same time, the mean of ApoA1 was markedly higher (P < 0.05) in combined norethisterone; the ratio of ApoA1/ApoB (1.87 +/- 0.58) in the combined norethisterone group was superior to the ratio value (1.68 +/- 0.55) in norgestrel group. CONCLUSIONS: These beneficial effects on lipid metabolism have been considered indicators of potential cardiovascular protective effect of the combined norethisterone for taking pill less than 15 years, but these protective effects would be reduced with adverse change in lipid and lipoprotein parameters for taking combined norethisterone more than 15 years. In contrast, the mean of TC, LDL-C, two known risk factors for cardiovascular system, in the norgestrel use less than 15 years, after the adjusting for age, were significantly increased (P < 0.05, P < 0.01), and adverse changes in the TC/HDL-C ratio (P < 0.05) and ASI value, compared with the combined norethisterone; Lp(a) level was markedly higher in the norgestrel group than that in the control group (P < 0.05). These adverse effects on lipid metabolism have been considered indicators of potential cardiovascular harmful effect of low-dose norgestrel.

Adult↗
PubMed1998

Growth hormone responses to continuous and intermittent exercise in females under oral contraceptive therapy.

In this study we investigated the effect of oral contraceptive (OC) use (OCU) and non-use (OCNU) on growth hormone (GH) responses to exercise in the same females (n = 7, age 22-31 years) during the normal course of OC therapy. Continuous (60% maximum oxygen consumption, VO2max for 20 min) and intermittent exercise (>80% VO2max) protocols of equal total duration, and similar external work were performed during phases of OCNU (days 3-5 of the menstrual cycle) and OCU (days 7-11). Levels of GH, lactate, 17 beta-estradiol, and progesterone were measured. Lactate responses were significantly greater (P<0.05) during intermittent than continuous exercise, with no effect of OC use. However, significantly greater GH responses were found during the OCU phase than the OCNU phase in both the continuous (+94%) and intermittent (+250%) exercise protocols. Estradiol and progesterone levels increased significantly during exercise in all four conditions. We suggest that the increased GH responses observed during the OCU-phase were potentiated by the elevated levels levels of total estrogens (endogenous 17 beta-estradiol and exogenous ethinyl estradiol). It is suggested that training programs for female athletes could be timed in accordance with the menstrual cycle to benefit from an increased GH response to exercise during phases of OC use or the luteal phase of women not on OC therapy.

Adult↗
PubMed1995

Unintended pregnancies and use, misuse and discontinuation of oral contraceptives.

Unintended pregnancies are a recognized occurrence among women using oral contraceptives (OCs) as a consequence of both user and method failure. However, OCs also influence the occurrence of unintended pregnancies through an additional, poorly recognized, route: cessation of OC use by women who do not wish to become pregnant but stop using OCs because of side effects or other reasons. Many such women fail to immediately substitute a new contraceptive and/or adopt a less reliable contraceptive. This is a particularly important consideration for the approximately 3.7 million women who begin taking OCs in the United States each year since this group commonly experiences side effects and has a high discontinuation rate. Using a decision tree to follow a cohort of OC users over one year, we estimate that over 1 million unintended pregnancies are related to OC use, misuse or discontinuation. The greatest proportion of these, 61%, occur in women who discontinue OCs; of these, 66.6% occur in women who fail to immediately substitute other contraceptives and 33.3% because of the adoption of less reliable contraceptive methods. Of continuing OC users, the majority, exhibiting good compliance, contribute 24% of pregnancies because of their large numbers. Continuing OC users who are poor compliers, though many fewer, are responsible for 15% due to their high pregnancy rate. Unintended pregnancies in women who discontinue OCs account for approximately 20% of the 3.5 million annual unintended pregnancies in the United States, incurring costs of nearly +2.6 billion.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraception Behavior↗
PubMed1991

Different contraceptive practices: use of contraceptives in Finland and other Nordic countries in the 1970s and 1980s.

Contraceptive practices, especially oral contraceptive and intrauterine device use, were studied in four Nordic countries by recalculating published and unpublished data from previous surveys and statistics and by collecting new data from Finland. The sales of oral contraceptives were presented in defined daily doses, and the percentages of women using oral contraceptives were estimated from them. The percentages of intrauterine device users were calculated taking into account the number of intrauterine devices sold each year and the continuation of use from previous years. The results of the surveys were reanalysed. We found clear differences in contraceptive practices. Oral contraceptive use was most prevalent in Sweden and Denmark, and, especially at the end of the 1970s, Finnish intrauterine device use was very high. In the 1980s the differences dimished somewhat. These disparities in culturally and economically similar countries indicate that further research is needed to evaluate the factors influencing contraceptive practices.

Adolescent↗
PubMed1978

Estimating the effects of contraceptive use on fertility: techniques and findings from the 1974 Philippine National Acceptor Survey.

Survey data on contraceptive use-effectiveness and on the fertility of family planning acceptors can provide a useful basis for estimating the fertility effects of a family planning program. The 1974 Philippine National Acceptor Survey (NAS), a sample survey of nearly 3,000 family planning acceptors reported by clinics in 1970--72 and interviewed in 1974, provided data for such an evaluation of the Philippine family planning program. The program's effects on the fertility of acceptors were estimated utilizing a series of analytical techniques, which are described in this article. Data from the NAS on continuation, pregnancy, and fertility following acceptance, as well as estimates of fertility decline associated with acceptance and continuing use of contraception, are analyzed. Findings are presented for acceptors of the four major program methods--pills, and the IUD, rhythm, and condoms. An appendix presents special procedures employed in estimating fertility effects.

Adolescent↗
PubMed1979

New long-acting injectable microcapsule contraceptive system.

A new long-acting, injectable contraceptive which provides continuous controlled release of the steroid norethisterone (NET) for a precise period of 6 months following a single intramuscular injection is described. The prototype system consists of microcapsules made of the biodegradable polymer d, l-polylactic acid, in which micronized crystals of NET are homogeneously dispersed. NET is slowly released from the microcapsules following intramuscular injection at a rate of 0.90 microgram NET/day/mg of microcapsule by diffusion of the steroid from the polymer matrix. Three different doses of a standard preparation of microcapsules were tested in normally cycling female babbons (4 to 5 baboons/group). Following injection of either 300, 200, or 100 mg of microcapsules containing 75, 50, or 25 mg of NET, blood samples were collected at selected intervals and analyzed for NET, estrogen, and progesterone by radioimmunoassay. All three doses provided continuous NET release for 6 months following injection. The NET serum profiles for the different doses are parallel, and ovulation was inhibited in all baboons for 6 months following treatment.

Animals↗
PubMed2003

ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 46, September 2003. (Replaces technical bulletin number 222, April 1996).

Bilateral tubal sterilization and vasectomy are both safe and effective permanent methods of contraception; more than 220 million couples worldwide use them as their contraceptive method of choice. Sterilization continues to be the most commonly used contraceptive method in the United States, with 11 million U.S. women relying on the method. Approximately 700,000 tubal sterilizations and 5000,000 vasectomies are performed in the United States annually. The purpose of this document is to review the evidence for the safety and effectiveness of sterilization in comparison with other forms of contraception, as well as evidence of the likelihood that a woman will regret having had a sterilization procedure.

Female↗
PubMed1992

Oral contraceptives and cycle control: a critical review of the literature.

Control of spotting and breakthrough bleeding and absence of withdrawal bleeding, collectively termed cycle control, is the single most important determinant of whether a new user of oral contraceptives (OCs) will continue this method. However, information about different OC preparations and how they affect such problems, including the effects of progestogen and estrogen phasing and the components of these hormones, is scant and confusing. Studies cited in this report reveal highly variable rates of bleeding problems in women taking OCs: after 6 months of OC use, the prevalence of spotting varied between 0% and 8.5%; of breakthrough bleeding, 0% and 12.2%; and of amenorrhea, 0% and 5.8%. At least some of this variation is attributable to differing study populations and cultures, study designs, and the manner in which data were collected and reported. However, methodologic weaknesses were common, often involving lack of randomization and blinding, and attrition rates were high. Despite these limitations, it is clear that the frequency of bleeding problems decreases with continuing use of OCs, emphasizing the need for patient reassurance about the transient nature of these problems. In addition, gestodene-containing preparations appear to offer better cycle control than do desogestrel-containing preparations and levonorgestrel-containing preparations better control than norethindrone-containing preparations. However, the strongest lesson to emerge is the need for more rigorous studies to adequately address questions of comparative bleeding problems, particularly with newer triphasic formulations. These conclusions underscore the importance of counseling new OC users about the possibility of bleeding problems, reassuring them that most such problems are temporary, and, that if compliance is maintained, these will not impair contraceptive efficacy.

Contraceptives, Oral, Combined↗
PubMed1996

The introduction of a new contraceptive; two years experience with Norplant.

OBJECTIVE: To determine the uptake, acceptability and continuation rates of a new contraceptive implant, Norplant. DESIGN: Review of case notes of all acceptors during the two years following the introduction of the implant. SETTING: A large family planning clinic in Edinburgh. SUBJECTS: All women choosing Norplant. RESULTS: 508 women chose Norplant, many as an alternative to sterilisation or because they had experienced problems with other methods of contraception. 9% of women were lost to follow-up. Of the remainder continuation rates were 84% at one year and 80% after 18 months of use. 43% of women gave bleeding problems as the reason for removal. However the combination of weight gain, mood swings, depression and headache was frequently reported as unwanted side effects by women seeking removal. No major problems were experienced with either insertion or removal of Norplant. CONCLUSIONS: Norplant is an effective method of contraception which many women find attractive. The incidence of erratic bleeding is high but many women tolerate this problem because the method is easy to use and lasts five years. Careful counselling is essential for high continuation rates.

Adolescent↗