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PubMed1991

Contraception with progestogens and progesterone during lactation.

The growth and development of breastfed infants whose mothers used the contraceptive implants Norplant containing levonorgestrel and the injectable containing norethisterone enanthate were studied. Each group comprised of 120 women who initiated the use during the 5th to 7th week postpartum and were compared with a similar number of IUD using mothers. The breastfeeding performance did not differ between groups. The infants of the three groups performed similarly as regards their physical growth and health as well as the time of acquisition of the various milestones of psychomental development. A vaginal ring releasing 10 mg of the "natural" progesterone per 24 h was tested in breastfeeding mothers. The continuous use of the ring produced a serum level of progesterone around 4 ng/ml. This was effective in augmenting lactational infertility even through the later phases of breastfeeding when such an effect starts to wane off. The use of the ring proved to be acceptable and had no ill-effect on breastfeeding or infant growth or health. Using the natural progesterone as a contraceptive adds a new measure of safety, since the amount of the steroid secreted in the mother's milk will not be effectively absorbed from the infant's gut. These studies suggest the possibility of using two new methods for breastfeeding mothers; Norplant and the progesterone vaginal contraceptive ring. These can be initiated early postpartum, whenever this is considered needed.

Contraceptive Devices, Female↗
PubMed1989

The effect of sexual behavior and a pregnancy on contraceptive method switching among black female teens.

Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic, determinants of method switching in four areas were investigated. Method switchers, those who switched from an unprepared to a prepared method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.

Adolescent↗
PubMed1988

Assessing changes in vaginal bleeding patterns in contracepting women.

In clinical trials comparing alternative contraceptive methods, women often discontinue for disturbances in menstrual bleeding patterns. Vaginal bleeding diaries have been used to monitor these patterns, and this paper suggests two new methods of analysis of these data. One analysis measures trends over time in the occurrence of specific patterns and, a second analysis, the relation between a woman's current experience and the probability of continuing method use. Contrasts between these approaches and the reference period method of analysis are made. A randomised clinical trial of the relative efficacy of 100 and 150 mg doses of depot-medroxyprogesterone acetate (DMPA) is used for illustration.

Amenorrhea↗
PubMed1979

A randomized double blind study of two oral contraceptives.

To study the question of whether one brand of oral contraceptives may be as acceptable as another for use of publicly-assisted family planning programs, a double blind study of two well-known brands, Ovral and Norinyl, was undertaken in Costa Rica and Trinidad. The pills were randomly assigned to 1,200 women. Common side effects - nausea, dizziness, vomiting, headaches - were associated with both Norinyl and Ovral. Differences in event rates for these conditions were much more marked by country than by the pill used. Ovral was associated with increases in skin problems, notably chloasma, in Cost Rica. A higher percentage of women using Norinyl reported intermenstrual bleeding and spotting in both countries. In Costa Rica continuation rates for Norinyl were adversely affected by this. With these exceptions there appear to be no important differences between the brands that would affect their use in family planning programs.

Adolescent↗
PubMed1992

Desogestrel-ethinylestradiol, an oral monophasic contraceptive. Clinical and lipid metabolic effects: a 5-year experience.

A comparative study of 5 years' duration using desogestrel (DSG), levonorgestrel (LN), and norethindrone (NET), combined with ethinyl estradiol (EE), was conducted. A total of 4499 cycles on DSG-EE, 3691 on LN-EE (1980 on triphasic and 1711 on monophasic schemes) and 1680 on NET-EE was evaluated. A contraceptive efficacy of 100% was obtained in all the groups. Minimal side effects were observed. In particular, body weight in those women on DSG-EE did not show noticeable changes and headaches were minimal. No alterations on blood pressure readings or on the routine laboratory tests were noticed in any of the groups. There was a significant increase in high-density lipoprotein-c (HDL-c) in women on DSG-EE. There was no change in NET-EE, and a significant decrease in women on LN-EE in both schemes. Changes in LDL-C, very low density lipoproteins, triglycerides, total lipids, total cholesterol, and glucose were not significant, although there was some increase at 60 cycles on triglycerides on those women on DSG-EE and on NET-EE. At the end of 5 years, 76% of women continued on DSG-EE. They indicated their satisfaction with this method.

Americas↗
PubMed1984

On the origin and histological structure of adenocarcinoma of the endocervix in women under 50 years of age.

In the last 10 years 28 adenocarcinomas of the endocervix developing in women up to the age of 50, have been encountered at our clinic. Of these women, 23 (82%) had taken oral contraceptives, in most instances continuously for up to 19 years, and for a median of 10 years. During the same period of time, 12 adenocarcinomas in situ of the endocervical mucosa were seen, 11 of which developed after 1 to 20 years of use of oral contraceptives. In contrast, only 40% of women with invasive squamous carcinoma under age 50 had used oral contraceptives. Fourteen of the 23 patients with invasive adenocarcinomas and 9 patients with adenocarcinoma in situ had taken contraceptives containing a potent gestagen, Norgestrel; the others had taken either Norethisterone acetate or Lynestrenol, usually in relatively high doses. Microscopically, the adenocarcinoma in the 28 women occurred in 3 forms, two of which did not appear in the 5 noncontraceptive users. In the women taking oral contraceptives, microglandular hyperplasia of the endocervix was diagnosed either prior to or coincident with the adenocarcinoma. The clinical observations are supported by experimental findings: 2 of 12 rhesus monkeys treated for 10 years with medroxyprogesterone acetate at doses 50 times those prescribed for women developed a similar type of adenocarcinoma. The longterm use of synthetic gestagens may be causally related to the development of endocervical adenocarcinoma.

Adenocarcinoma↗
PubMed1999

GyneFIX. The frameless intrauterine contraceptive implant--an update for interval, emergency and postabortal contraception.

This article reviews the clinical experience with the GyneFix intrauterine implant system for interval, emergency and post-abortal contraception. The relatively high rate of unintended pregnancies and abortions in the world signifies that greater access to contraception is necessary. Unwanted pregnancies and abortions could be avoided by widening the range of effective and acceptable contraceptive methods for use in situations where current methods are far from optimal. High effectiveness, protection against sexual transmitted infections, long duration of action, reversibility and safety are some of the most important attributes of contraceptives valued by women. The development of the frameless intrauterine device is a response to the need to develop contraceptives with high user continuation rate. GyneFix has the lowest failure rate of all copper IUDs currently available. Its performance is further optimised by the atraumatic frameless design which minimises the side effects and discomfort experienced with conventional IUDs. GyneFix could, therefore, be a useful new contraceptive option in looking at ways to reduce the number of unwanted pregnacies and induced abortions.

Abortion, Induced↗
PubMed1990

[Interruption of pregnancy in Switzerland 1982-1986].

Official statistics available for the 5-year period considered in this paper reveal a general trend: decrease in the number of terminations, in absolute terms, both in women non-resident and in women resident in Switzerland. Amongst the latter, figures show a relative decrease in the 15 to 44-year age group and in relation to birth rate. Attitudes in 'liberal cantons' concerning termination of pregnancy are clearly justified. Efforts to ensure more widespread use of modern contraceptive methods must be continued (in conjunction with AIDS prevention).

Abortion, Induced↗
PubMed1986

Contraceptive steroid effects on nonreproductive organ systems.

Oral contraceptives affect many organ systems in addition to the reproductive tract. In some cases the alteration is just a clinical laboratory test result value; in others it represents a true alteration in metabolism, with the induction of increased enzyme activity. Even with the markedly reduced steroid content of today's oral contraceptives, the practitioner must continue to be aware of these potential and real effects on nonreproductive organ systems.

Adenoma↗
PubMed2000

Norplant use among urban minority women in the United States.

The aim of this study was to develop a profile of urban American women who chose Norplant(R), determine factors associated with retention and early termination of implants, and to determine reasons for early removal. A total of 197 adult black and Hispanic women who had Norplant inserted were followed prospectively for up to 5 years. Interval and cumulative termination rates were calculated. Data were stratified by race and analyzed to include lost-to-follow-up (LTFU) subjects. Multivariate survival analysis was used to determine variables independently associated with termination. Cumulative continuation rates were 68% after year 1 and 13% after year 4. Significant predictors of retention included black race and lower parity. Probability of early termination increased with higher parity and Hispanic race. For black subjects, recent use of hormonal contraception was a predictor of retention. Menstrual changes and weight concerns were common reasons for removal. The Norplant 1-year continuation rate is lower than previously reported, but is higher than reported for oral contraceptives and Depo-Provera(R). Future studies should stratify by age, race, and parity, and use standardized terminology to report intervals of use.

Adult↗
PubMed2004

A refractory fixed drug reaction to a dye used in an oral contraceptive.

A young woman presented with a classic fixed drug eruption (FDE) after taking the inactive green pills of her oral contraceptives (OCs). The patient's history was unique in that the FDE did not occur every time she took the inactive pills but was refractory, occurring every third month within hours after she took the green pills. After discontinuing the green pills but continuing the active oral contraceptive pills, the patient has not experienced a recurrence of the rash in more than 2 years. This case report reviews the unusual phenomenon of refractory periods in FDEs and highlights the importance of understanding this phenomenon in the diagnosis of drug eruptions.

Adult↗
PubMed1982

A comparative study of the effectiveness of the Lippes Loop, the Copper-T-200, and the Nova-T intrauterine contraceptive devices in Lagos, Nigeria.

Two hundred five women attending the Family Planning Clinic of the Department of Community Health were admitted into a nonrandomised study to compare the effectiveness of the Copper-T-200, Nova-T, and Lippes Loop intrauterine devices. Members of the study group of women were found to be older than their European counter-parts and also tended to have a higher parity (81.0% of the total group having more than three children). The expulsion rates and removal rates for bleeding and pain for Copper-T-200 and Nova-T users were respectively 6.5 and 3.8 and 5.0 and 1.5. These results were significantly lower than the rates for the Lippes Loop users which were 14.7 and 6.7, respectively. The continuation rates were higher for the Copper-T-200 (88.2) and the Nova-T (91.3) than for the Lippes Loop (75.5). These findings were essentially similar to those of other worldwide studies.

Adult↗
PubMedDate not supplied

Acceptance and perceptions of NORPLANT among users in San Francisco, USA.

Two hundred and five women participating in a five-year clinical trial of NORPLANT and NORPLANT-2 were interviewed about their contraceptive and reproductive history, sources of information and knowledge of NORPLANT, experiences using the method, and the impressions of friends and family about the method. The most common reasons for trying the implants were dissatisfaction with other methods and perceptions about NORPLANT's ease of use. Forty-one percent of acceptors had anxiety prior to insertion; 49 percent of these feared pain, but only 5 percent said that they actually experienced significant pain. Women also feared implant removal, but their fear did not influence their decision to continue or discontinue use, and 74 percent reported little or no pain at removal. Most of the women were pleased with NORPLANT, although 95 percent reported side effects, with 82 percent reporting changes in menstruation. More than one-half of those women who discontinued reported that they would use the implants again. Seventy-four percent of the current users interviewed said they would like to use the implants in the future. For the women enrolled in the clinical trial, NORPLANT appeared to be a highly acceptable method of contraception, despite the frequent occurrence of bothersome side effects.

Adult↗
PubMed1999

Prospective multicentre study comparing levonorgestrel implants with a combined contraceptive pill: final results.

Norplant is a hormonal, long term method of contraception requiring the sub-dermal placement of six flexible capsules containing levonorgestrel in the inner aspect of the upper non-dominant arm. This open, prospective, multicentre, parallel group study, comparing the acceptability of Norplant and a combined pill, was originally designed to follow 700 subjects for five years, but was discontinued early. The main outcome criteria were duration of use and reason for discontinuation if appropriate. This final analysis, concerning the 364 subjects who used the implant and 307 subjects who used a gestodene/ethinyloestradiol combined pill, shows a statistically significantly higher (p<0.001) continuation rate amongst the implant users at 83.4 per cent compared to the pill users at 64.4 per cent at one year and this difference decreased only slightly by two years. The most common reasons for discontinuation by the end of the study were adverse events in both groups (menstrual and then mood changes in the implant group and mood changes and then headaches in the pill group). From the whole cohort the proportion which were 'very satisfied' were higher in the implant group (28.5 per cent compared to 14.6 per cent). This study confirms, in the UK, a high continuation rate for implant users similar to other countries as reported in the literature. If acceptability and continuation rates are similar in the none study setting, then a substantial number of women will seek removal of the implant and possible reinsertion five years after the time of initial high popularity (ie 1999). Doctors need to be prepared for this possible high level of activity.

Adolescent↗
PubMedDate not supplied

When children have children: the teen pregnancy predicament.

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

Abortion, Induced↗
PubMed1993

Phase III clinical trial with Norplant II (two covered rods): report on five years of use.

The subdermal implant NORPLANT II contraceptive was studied for its safety, efficacy and acceptability over a period of 5 years of use in a phase III multicentre clinical trial. A total of 1,466 women were observed for 52,849 women-months of use. Only four pregnancies were reported during the study period, giving a method failure rate of 0.8 per 100 users at 5 years of use. The continuation rates were 61.4, 49.0 and 42.1 per 100 users at 3, 4 and 5 years of use, respectively. The majority of the discontinuations were due to bleeding irregularities which accounted for 22.2, 26.3 and 28.5 per 100 users at 3, 4 and 5 years of use, respectively. The next common reason was planning pregnancy which was observed mainly in women having one child. The discontinuations due to infection, expulsion or displacement of device were very low (0.2-0.3 per 100 users). Due to vigorous efforts made by the centers to follow the subjects, the lost-to-follow-up rate was very low (1.6% at 5 yr).

Adolescent↗
PubMed2002

Legal abortion in South Australia: a review of the first 30 years.

OBJECTIVES: To review the first 30 years' experience of legal abortion in South Australia and its demographic implications. DATA AND METHODS: Information was obtained from official abortion statistics and demographic publications of the Australian Bureau of Statistics. Standard demographic and statistical techniques of analysis were used. RESULTS: After an initial rise during the 1970s, abortion rates remained fairly constant for the next decade but have increased since 1990. The Pregnancy Advisory Centre opened in 1992, to reduce waiting times and to cater for late abortions. This resulted in an increase in abortions earlier in pregnancy and also an increase in late abortions. With the adoption of vacuum aspiration techniques and improved services, abortion is now a day-only procedure, performed by specially trained doctors. Morbidity and mortality have been greatly reduced. Concurrent sterilisation has also declined. The increase in abortion has affected all age groups, but particularly women under 30, consistent with the national trend towards the postponement of births. After an initial rapid decline, the total pregnancy rate has risen slightly since 1990, showing changes in patterns of contraceptive use. However, this is not reflected in an increase in the total confinement rate. CONCLUSION: Overall, contraception has had a greater effect than abortion in reducing births in South Australia. The abortion rate is still lower than in the rest of Australia as calculated from Medicare data, even though this is an underestimate because it includes only fee-paying patients. There remains a need for continuing emphasis on better contraceptive use, including emergency contraception.

Abortion, Legal↗