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PubMed2002

Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception.

BACKGROUND: The aim of this study was to investigate the association of total duration of oral contraceptive usage with time to conception. METHODS: This was a prospective study of 8497 planned pregnancies drawn from a population that recruited 85% of eligible couples in South-West England who were expecting a baby in a 21 month period. Self-completion questionnaires were administered at 18 weeks gestation to ascertain parity, paternity, co-habitation, use of the contraceptive pill, smoking and alcohol status, educational achievement, height, weight and time taken to conceive. Logistic regression was used to identify factors independently related to conception in < or =12 months. RESULTS: Of the participants, 74% conceived in < or =6 months, 14% in 6-12 months and 12% after 1 year. Previous prolonged oral contraceptive usage was statistically significantly associated with a decreased risk of delayed conception. Prolonged use of oral contraception was also associated with improved fecundity independent of other factors. Selection bias due to particularly fertile women using oral contraceptives is unlikely because similar odds ratios were calculated for nulligravid women. CONCLUSIONS: Women who have prolonged use of oral contraceptives might be reassured that they will not be disadvantaged in terms of time taken to achieve conception.

Adult↗
PubMed1980

Oral contraceptives raise the cholesterol saturation of bile by increasing biliary cholesterol secretion.

To discover the mechanism by which oral contraceptives increase the level of cholesterol saturation of human bile, we measured biliary lipid secretion rates, gallbladder and hepatic bile lipid composition, bile acid pool size, bile acid composition, and plasma lipoprotein levels in five healthy women during routine oral contraceptive treatment and again during normal menstrual cycles on no medication. The molar percent cholesterol in both gallbladder and hepatic bile was higher in every subject while taking oral contraceptives (p less than .02). Oral contraceptive usage was accompanied by a significant enhancement of biliary cholesterol secretion (65 versus 46 mg/hr, p less than .01), but there was no significant change in bile acid or phospholipid secretion, total bile acid pool size, or bile acid composition. These findings indicate that oral contraceptive usage increases biliary cholesterol secretion, thereby raising the level of cholesterol saturation of bile and predisposing to cholesterol precipitation and gallstone formation.

Adult↗
PubMedDate not supplied

Contraception: awareness and practice amongst Nigerian tertiary school girls.

Contraception is analysed in 498 Nigerian Tertiary School Girls--228 from the Medical Discipline (MD) of study and 270 from the Non-Medical Discipline (NMD). Pregnancy occurred in 30.5% of the sexually exposed students. Overall mean awareness of contraception was 70.9% while mean contraceptive usage was 23.5%. The most commonly used contraceptive method was the safe-period. Peer group constituted the highest source of information on contraception (42.6%) while lectures constituted the lowest (11.2%). Sex and contraceptive education entrenched into the country's education policy is advocated.

Adolescent↗
PubMed1988

In-vivo measurement of spin lattice relaxation time (T1) of bone marrow in healthy volunteers: the effects of age and sex.

Magnetic resonance images of the spine, sternum, femoral heads and upper femoral shafts were obtained from 90 healthy volunteers to determine the normal ranges of spin lattice relaxation time (T1) for different regions of the bone marrow. The influence of age, sex and oral contraceptive usage on bone marrow T1 was assessed. Differences observed between the T1 of the various regions of the bone marrow examined were consistent with the expected distribution of erythropoietic cells and fatty marrow. Bone marrow T1 was found to decrease with age, significantly lower mean T1 values being observed in subjects over 40 years of age than for those in the 20-40 years age group. The mean bone marrow T1 of females in the 20-40 years age group was significantly higher than that for males of comparable age. For subjects over 40 years of age, the difference in bone marrow T1 observed between males and females was not significant. Oral contraceptive usage had no effect on bone marrow T1.

Adult↗
PubMed2004

Emergency contraception and morality: reflections of health care workers and clients.

In this study, we explore the retrospective reports of 21 US Planned Parenthood clients about their use of emergency contraception pills (ECPs) and the views of ten Planned Parenthood health care workers at two clinics about providing ECPs. We elucidate the sociological phenomena that frame emergency contraception usage: cultural ideology about contraception, sexuality, unintended pregnancy, and abortion. We focus on the ways in which interactions between health care workers and clients both mediate and reinforce such cultural ideology. Our research indicates that the distinctions between fertilization and pregnancy, between contraception and abortion, between responsible and irresponsible procreative behavior, are not hard and fast boundaries upon which everyone agrees. We illuminate the dividing lines and continuities our participants invoked, affirmed, and questioned when contemplating the continuum from potential fertility to realized (and unwanted) pregnancy.

Abortion, Induced↗
PubMed1997

Use of contraception in women who present for termination of pregnancy in inner London.

OBJECTIVES: To describe the contraceptive usage of women undergoing termination of pregnancy in order to identify problems with contraception, and therefore suggest ways in which contraceptive services can be improved. DESIGN: Prospective study of attenders for NHS termination of pregnancy over a three month period. SETTING: Community based assessment clinics for NHS termination of pregnancy in inner London. SUBJECTS: Two hundred and sixty-nine women asking for assessment for NHS termination of pregnancy. MAIN OUTCOME MEASURES: Source of contraception, method used around time of conception, and problems experienced. RESULTS: Respondents tell into three groups: those using contraception around the time they became pregnant; those who had ceased to use contraception; and those that had never used contraception. The method of contraception used by the majority of the first group was the condom and the main source of the method was the chemist shop. The second group had most commonly used oral contraceptives in the past and had ceased use in many cases as a result of side effects. The majority of the third group did not speak English and had limited knowledge of methods of contraception. CONCLUSIONS: High usage of chemists means women avoid service providers who could offer help and advice. Women were prepared to put themselves at risk of unwanted pregnancy rather than return for further help and the lack of knowledge about emergency birth control was of some concern. The needs of black and ethnic minority women requires detailed work to improve access and acceptability of contraceptive services.

Adolescent↗
PubMed1993

Information needs on emergency contraception not being met.

During the 1980s, there was 2 prominent changes in family planning: more women went to general practitioners (GPs) for contraceptive advice and there was an upturn in the use of condoms due to safer sex campaigns in the mid-80s. In this study of 769 women requesting a pregnancy termination, the author's found that the greater use of condoms had appeared to increase the need for information about emergency contraception, but this was not being met. Patients advised by their GPs seemed to have a lower level of knowledge than those who obtained their contraception from clinics. The study, carried out at St. James's University Hospital in 1991-92, is compared with several studies in the 1970s and 80s which look at contraceptive usage by women with unwanted pregnancies. Differences were found between those receiving contraceptive advice from different sources (i.e. GPs, clinics, no medical source). Failure of the pill was more frequent in the GP-advised group, but failure of the diaphragm was more frequent in the clinic-advised group. Failure of non-use of condoms did not differ according to the source of advice. Knowledge of and use of emergency contraception was low. Only 14.5% of those using no contraception or recognizing a condom failure attempted to use a secondary or emergency method. Condoms should be used as well as rather than instead of other methods of contraception, and knowledge and availability of emergency contraception should be increased and promoted, recommend the authors. They concluded that problems arising from family planning provision by untrained and uncommitted doctors should be addressed urgently. (Bromham and Cartmill, British Journal of Family Planning, vol. 19, 1993, pp179-183). Commenting on the study findings, FPA Medical Information Office Jane Urwin said: "This study has furthered our knowledge in this area. It also highlights the need for further study of risk-taking behavior in relation to contraceptive use's.

Ambulatory Care Facilities↗
PubMed1997

A longitudinal study of birth control and pregnancy outcome among women in a Swedish population.

The prevalence of contraception and pregnancy outcome in the same women, at 19, 24, and 29 years of age, was assessed in a longitudinal cohort study using a postal questionnaire technique. A one-in-four random sample of all women born in 1962 and resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). Respondents from 1981 were re-assessed in 1986 and 1991. Four hundred thirty women (66%) answered the questionnaire on all three occasions and are included in the analysis. Contraceptive usage was as follows (at 19, 24, and 29 years of age, respectively): oral contraception (OC) 47%/51%/22%; intrauterine device 3%/11%/19%; barrier methods 12%/12%/20%; depot gestagen 0/0.2%/0.4%; no contraception 39%/26%/25%. OCs had been taken at some time by 93%. Reasons give for cessation of OC were: contraception not required 10%/21%/20%; fear of OC 28%/32%/35%; menstrual disorder 17%/13%/14%; weight increase 20%/16%/15%; mental side effects 14%/ 21%/20%; desire to become pregnant 7%/33%/52%. Pregnancy outcome was as follows: Ever pregnant 17%/42%/ 71%; children 5% had 1-2 children/27% had 1-3 children/ 59% had 1-5 children; 12%/25%/30% > or = 1 legal abortion; 3%/8%/15% > or = 1 miscarriage; and > or = 1 ectopic pregnancy 0.2%/1.2%/2.1%. On all three survey occasions, more than 97% of the legal abortions were performed < or = 12 weeks gestation. The complication rate following legal abortion was 7%. The proportion of live births to the total number of pregnancies was 25%, 45%, and 61%. The relationship between method of contraception, history of pregnancy, legal abortion, and smoking habits was analyzed in detail. Despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

Adult↗
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↗
PubMed1984

Abortion: predicting the complexity of the decision-making process.

This study sought to test a conflict theory model of decision-making in abortion. Complex, or conflicted, abortion decisions were defined as those occurring when the woman had desired pregnancy, when the abortion alternative was considered later, and when the decision process was lengthier and subjectively more difficult. Sets of personal and social variables, identified from previous research, were expected to require a more complex decision process. A second objective was to determine whether these variables would also predict previous contraceptive behavior. A large sample of abortion patients completed a survey of attitudes and behaviors related to the abortion decision and contraceptive usage. Results indicated that strong involvement with one's sexual partner tended to encourage contraception but complicated the abortion decision. Strong work commitment likewise encouraged contraception but appeared to simplify the abortion decision. While concern for personal health was significantly associated with contraceptive behavior, it was not related to the decision process in abortion. Interpretation suggested that prevention of unwanted pregnancy and the abortion decision are independent processes, both of which are affected by love and work but in opposite directions.

Abortion Applicants↗
PubMed1991

A longitudinal study of contraception and pregnancy outcome in a representative sample of young Swedish women.

The prevalence of contraception and pregnancy history in the same women, aged 19 and 24 years, was assessed in a longitudinal cohort study by means of a postal questionnaire. A one-in-four random sample of all the women born 1962, resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). The response rate was 91%. Respondents from 1981 were re-assessed in 1986 (response rate: 83%). The respondents from 1986 (n = 488) represent 74% of the original sample from 1981. Contraceptive usage in the same women aged 19 and 24 years (in brackets) was as follows: Oral contraception (OC) 47% (51%); intrauterine device 3% (11%), p less than 0.01; barrier methods 11% (11%); depot gestagen 0 (0.2%); no contraception 39% (26%), p less than 0.05. OCs were being taken or had been taken by 89%. Reasons given for cessation of OC were as follows: Contraception not required 10% (15%); fear of OC 26% (29%); menstrual disorder 17% (14%); weight increase 18% (10%), p less than 0.05; mental side effects 15% (9%); desire to become pregnant 7% (17%), p less than 0.01. Pregnancies (n = 362) were reported by 194 (43%) of the women. 44% of the pregnancies terminated in legal abortion. The medical complication rate following legal abortion was 15%. Thus, despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

Adult↗
PubMed1981

Oral contraceptive exposure of amenorrheic women with and without prolactinomas.

The purpose of this study was to determine the extent of oral contraceptive (OC) exposure of women with secondary amenorrhea of hypothalamic-pituitary etiology. In 93 of 126 women with secondary amenorrhea sufficient data were obtained regarding menstrual history and OC exposure: 26 patients had evidence of a prolactinoma, an additional 26 patients had idiopathic hyperprolactinemia without evidence of a pituitary tumor, and 41 had "pure" dysfunction hypothalamic-pituitary amenorrhea. After stratification by age at diagnosis and parity the estimated odds ratio for past oral contraceptive usage showed no differences among the three groups (odds ratios between 0.74 and 1.48). Using the chi-square test the proportion of subjects who had regular menses before oral contraceptive intake and developed anovulation immediately after discontinuance ("post pill amenorrhea") in the three groups also showed no difference (x2 = 0.60, P = 0.74). These data indicate that non-ovulatory patients are likely to have been exposed to OC, and do not indicate that patients with prolactinomas differ in the extent of their OC exposure from other specified groups of patients with secondary.

Adenoma↗
PubMed1981

Teratogenic hazards of oral contraceptives analyzed in a national malformation register.

During the period 1967-1976, prospectively collected data were available in the Finnish Register of Congenital Malformations on the contraceptive usage of 3,002 mothers of children with malformations detected at birth, as well as of time-matched and place-matched control mothers. The distributions of the various types of malformations were similar among contraceptive users (immediately prior to or during the pregnancy) and nonusers. The total incidences of various methods of contraception were also similar among mothers of malformed children and the control mothers. The risk ratio method for matched pairs allowed us to evaluate the strength of the observed negative correlation concerning oral contraceptives. Thus, we could exclude with 95% confidence any effect larger than 5% of oral contraceptives on the incidence of visible malformations.

Abnormalities, Drug-Induced↗
PubMed1989

Sexual behavior, contraception and unintended pregnancy among young females.

Information about contraceptive usage and sexual experiences was sampled in 1985-86 from 16-20-year-old Danish females admitted for legally induced abortion on Funen (N = 140). In attempts to elucidate the causal relations behind undesired pregnancy among teenagers, data were in the present context compared with answers to the same questions from a representative Danish sample of sexually experienced, non-pregnant females of the same age (N = 201). Of the reference sample, 83.6% were using contraceptives at the time of the interview--mostly oral contraceptives (O.C.). Of the abortion sample, 90.7% said they had used contraception earlier in their reproductive life. Approximately one third conceived in spite of contraception (most frequently the condoms). O.C. was the contraceptive method used most recently (by 43.6%). Thus, a pause in an effective contraceptive often precedes an unintended pregnancy, pointing to the need for follow-up counselling when O.C. is prescribed to teenagers. Only the minority could state the total number of times they had experienced sexual intercourse. Significantly more females in the abortion sample were in an alliance with a male partner with whom they had regular sexual intercourse. However, they also reported a higher average number of different sexual partners, indicating an association between changing sexual relationships and undesired pregnancy. In the abortion sample significantly more pregnancies prior to the index pregnancy were reported during a corresponding period of risk of conception lasting only a few years. Taking the widespread use of contraception into account, it is possible that an increased fecundity might be a co-factor behind unsuccessful contraception.

Adolescent↗
PubMed1985

Post-tubal sterilization syndrome--a misnomer.

Menstrual parameters and gynecologic symptoms of 389 women who underwent laparoscopic tubal banding were studied prospectively and longitudinally. Previous oral contraceptive users exhibited an immediate increase in menstrual flow and dysmenorrhea, which declined slightly with time. No such changes occurred in women who used other methods of temporary contraception. A significant increase in noncyclic pelvic pain, independent of previous contraceptive usage, developed only in women greater than 38 years of age. Menstrual cycles and dyspareunia were not affected. A small control group of women whose husbands underwent vasectomy showed no significant changes in any of these parameters.

Adult↗
PubMed1980

Characteristics that predict risk of breast cancer before and after the menopause.

In a case-control study of 1868 breast cancer patients and 3391 control patients we searched for characteristics that predicted risk of breast cancer diagnosed before and after menopause. Common to increased risk of this disease in both periods of womanhood were: early menarche and late menopause; delayed marriage and first childbirth; more nulliparity or reduced gravidity and parity; reduced frequency of abortions; shorter overall child-bearing interval; more advanced education, higher socioeconomic status, and more contraceptive usage; and familial tendencies toward the disease. Breast cancer patients diagnosed before menopause were leaner than controls at age 20 and at time of diagnosis, but breast cancer risk in the postmenopausal period was related to increased weight-for-height at diagnosis and greater weight-for-height at diagnosis and greater weight gain since age 20. Postmenopausal breast cancer patients had a longer interval between first and second childbirths. Frequency and duration of the gravid state, inversely related to breast cancer risk, were largely dependent on contraceptive practices rather than unexplained infertility per se. Whether the breast cancer reaches diagnosis before or after menopause, the bulk of evidence examined here supports the view that it has a common cause and is subject to modifying influences over the long period of cancer latency.

Abortion, Spontaneous↗
PubMed1978

Management of teenage pregnancies in three different health care settings.

A retrospective study was undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings. The sites included the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center. Comparison of the three groups revealed that RAMP patients experienced a lower incidence of anemia and preeclampsia than patients in the other programs. At one year postpartum, 25% of the hospital clinic patients were using contraception compared to 45% for the health center and 49% for RAMP patients, compared to 15.8% for the health center and 6.5% for the RAMP group.

Adolescent↗
PubMed1995

Sexual activities of Malaysian adolescents.

This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.

Adolescent↗