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PubMed1993

[Ignorance and misconceptions in the use of contraceptive methods].

Good knowledge of the available contraceptive methods ensures better acceptability, continuity and satisfaction, and lower failure rates of these methods. This paper describes an inquiry on the contraceptive knowledge in 114 women attending three Brussels family planning clinics. Misconceptions, beliefs in false rumors, and considerable insufficiencies in knowledge were detected. In order to increase patient's ability to correctly use birth control methods, so as to lower unwanted pregnancy rate, efforts should be made by health practitioners as well as by mass media and teaching institutions.

Adolescent↗
PubMed1984

Use effectiveness of the Prentif cervical cap in private practice: a prospective study.

Of two-hundred-sixty women seeking cervical cap contraception, exactly half subsequently used the Prentif cavity rim cap as their sole method of contraception. The one year continuation rate for these exclusive cap users was 56.7 per hundred. No major side effects related to the use of the Prentif cap were observed in the course of this study, involving 918 women-months in year 1. Pregnancy and dislodgement of the cap during use were the principal reasons for discontinuation of exclusive use, with gross rates of 19.1 and 12.9 per 100 at one year, respectively.

Adult↗
PubMed2003

The 'frameless' intrauterine system for long-term, reversible contraception: a review of 15 years of clinical experience.

AIM: The development of the 'frameless' intrauterine system (IUS) is a response to the growing need to develop high-performing, long-acting, reversible, and acceptable contraceptives with a high continuation of use. METHODS: This is a review of 15 years of clinical experience in randomized controlled and non-randomized clinical trials. RESULTS: The IUS has a similar failure rate as the TCu380A Intrauterine device (IUD), considered the 'golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional 'framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15,000 woman-years experience. CONCLUSIONS: Young nulliparous/nulligravid and parous women may significantly benefit from the advantages the 'frameless' IUS, which could be strategically important to help in reducing the increasing number of unintended pregnancies and induced abortions worldwide. Furthermore, the 'frameless' IUS has been shown to be highly effective for emergency contraception and for immediate postabortal insertion. The long lifespan of the IUS could constitute a cost-effective reversible alternative to irreversible female sterilization.

Female↗
PubMed1976

[Effect of oral contraceptive on the pituitary and plasma L.H. levels and on the hypothalamic LH-RH level (author's transl)].

The effects of the oral contraceptive on the pituitary content and plasma level of LH and the hypothalamic LH-RH level were investigated in 16 adult female rabbits. The oral contraceptive preparation, Sophia-C (Norethindrone 2mg + Mestranol 0.1 mg), as administered orally by a stomach tube each day for 7 days in 8 adult female rabbits. At the end of the treatment, the rabbits were bled from the abdominal aorta into heparinized syringes and the plasma was separated. The stalk median eminences were excised. All the materials were stored in -80 degrees C until assayed. Plasma level and the pituitary content of LH and the hypothalamic LH-RH were measured by radioimmunoassay. All the dose response curved were drawn using logitlog transformation. Radioimmunoassay procedures for LH was described in detail elsewhere. Purified rabbit LH for iodination (125-I) and strandard were prepared by T. Makino and R.O. Greep, at Research Laboratories for Human Reproduction, Harvard Medical School, Boston, U.S.A. The starting B/T was 25% at the final dilution of the antibody of 1/20,000. Minimal detectable quantity was about 40 pg/tube. The 50% intercepts were approximately 460 pg/tube. Radioimmunoassay procedures for LH-RH were performed according to the method described by Arimura et al. Antiserum against synthetic LH-RH was kindly supplied to us by Drs. A. Arimura and A.V. Schally, New Orleans, U'S.A. The synthetic LH-RH was kindly supplied to us by Dr. N. Yanaihara. The starting B/T ratio was 29% at the final dilution of the antibody of I/17,500. Minimal detectable quantity was about 40pg/tube and the 50% intercepts were 150pg/tube. It has been assumed that oral contraceptive drugs exert their action by blocking the hypothalamic LH-RH, resulting in a depression of the plasma level of LH, because plasma level of LH returned to the normal level when LH-RH was administered intravenously even while oral contraceptive steroids were given continuously. However, these findings concerning the site of action of the drugs furnished only indirect evidences. The possibility of a direct inhibitary effect of these steroids on the anterior pituitary cannot be ruled out. Administration of 2mg of Norethindrone and 0.1mg of Mestranol significantly depressed both the pituitary content and the plasma level of LH. On the other hand, they significantly increased the hypothalamic LH-RH level. Those findings strongly suggested the direct action of this drug on the anterior pituitary in the female adult rabbits. Detailed mechanisms on how the hypothalamic LH-RH was increased were not known in this experiment, further investigations are now in progress.

Animals↗
PubMed1994

The use of contraceptive methods among women seeking a legal abortion.

In a simple random sample study of 404 women 20 to 29 years of age, 201 applying for abortion and 203 continuing their pregnancies, all were interviewed personally and requested to complete a questionnaire. The aim of the study was to analyse the use and experience of contraceptives among the abortion applicants in this age group, and to compare their experience with that of women in a matched control group. The most important reasons given for desisting in the use of contraceptives were the experience of side effects, worry about the side effects, and the "human failure" factor involved even with methods of contraception such as pills, which generally are regarded as safe. This study demonstrates that women living alone without any permanent relationship, having a strained economy or having previously had an abortion, need particular and detailed contraceptive advice plus continued close follow-up. To improve the continuation rate, precise contraception counselling focusing on both positive and adverse effects to reduce worry seems essential.

Abortion Applicants↗
PubMed1995

Vaginal bleeding patterns of women using different contraceptive methods (implants, injectables, IUDs, oral pills)--an Indian experience. An ICMR Task Force Study. Indian Council of Medical Research.

Irregularity in vaginal bleeding patterns is the most common clinical side effect causing discontinuation of the method reported by the-users of the newer contraceptive methods, especially hormonal ones. An objective assessment of vaginal bleeding pattern is, therefore, critical in evaluation of a new contraceptive method for its acceptance and continued use. The menstrual diary records of women participating in clinical trials of several contraceptive methods undertaken by the Indian Council of Medical Research were analysed. It was observed that the long-acting progestogen-only hormonal contraceptives like levonorgestrel (LNG)-releasing subdermal implants Norplant or intrauterine devices (LNG-IUD) as well as injectable contraceptive NET-EN 200mg given 2 or 3 monthly produced disturbances in bleeding pattern in the majority of their users. Very heavy or prolonged bleeding, a potential health hazard was uncommon and a shift more towards infrequent bleeding was observed. In Norplant-II implants users, 75 to 80% of women had irregularities in bleeding pattern during the first year of use which improved with prolonged use. However, even at 4 years of use, about half of the users of Norplant-II implants continued to have irregular bleeding patterns. The bleeding disturbances occurred in 80% users of 200mg NET-EN injectable contraceptives also during first year of use, however unlike Norplant-II implants users, there was no improvement with prolonged use. Combined monthly injectable contraceptives containing 50mg NET-EN and 5mg estradiol valerate caused less bleeding problems with half of the users experiencing normal pattern during one year of its use. Combined low-dose oral pills, both triphasic and monophasic, produced much better cycle control as compared to any of the other hormonal contraceptive-treated groups; about 90% of combined oral pill users had normal bleeding patterns during one year of method use. The use of copper IUDs was associated with increased bleeding in 18 to 20% of women during the initial period of three months which improved with prolonged use. It was observed that the women having frequent or prolonged bleeding had discontinued the contraceptive method more often as compared to those having delayed bleeding episodes or oligomenorrhoea. However, discontinuation rates due to bleeding irregularities at one year were lower in Norplant-II implants users as compared to other long acting hormonal contraceptive methods such as injectables or IUDs in spite of similar or better bleeding patterns in women using these methods.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed1994

Acceptability of the once-a-month injectable contraceptives Cyclofem and Mesigyna in Egypt.

A study of the acceptability of two once-a-month injectable contraceptives, Cyclofem and Mesigyna, in Egypt included 1091 women participating in the clinical trial of the two methods carried out during the period from November 1989 to July 1992. The acceptability of the two contraceptives proved to be high when measured by the rate of continuation at 12 months of injectable use, by method satisfaction, service satisfaction, rec recommending use to others, intent of future use, as well as willingness to pay for them when the injectables are marketed. The most important determinants of use discontinuation were young age, large family size, first time contraceptive use, previous experience with menstrual problems, dissatisfaction with clinic services, lack of counseling, lack of social support, as well as the husband's negative attitude towards contraceptive use. Side effects were more frequently reported by discontinuers; however, continuers appeared to be more tolerant of the same side effects. This study provided in-depth information about the social aspects affecting the acceptability of monthly injectable contraceptives in the different Egyptian localities, in addition to its being useful in monitoring activities in the clinical setting during these trials.

Attitude↗
PubMed1998

The contraceptive self-efficacy scale: analysis in four samples.

Previous research has established a relationship between contraceptive self-efficacy (CSE), as measured by the 18-item CSE scale, and young women's contraceptive behavior. In this paper, the authors continue to explore the scale and its relationship to contraceptive behavior with four diverse samples to establish generalizability and to set guidelines for use of the scale. A series of correlational analyses were conducted with each sample. A pattern of low correlations among CSE items across samples emerged, indicating that use of the total item set separately as the basis for CSE was warranted. Zero-order and partial correlations revealed which CSE items were correlated with contraceptive behavior as well as which items explained unique variance in contraceptive behavior for each sample. Regression analyses showed that CSE was significantly predictive of contraceptive behavior for all samples. These results are discussed in terms of scale properties and use in research and clinical settings. Educational implications are formulated as well.

Americas↗
PubMed1998

Effectiveness of Cyclofem in the treatment of depot medroxyprogesterone acetate induced amenorrhea.

A total of 100 women who were using depot medroxyprogesterone acetate (DMPA) for contraception and who had experienced at least 6 months of drug induced amenorrhea, were randomized to either switching their method of contraception to Cyclofem, or continuing with DMPA. At the end of 6 months, 82% of the Cyclofem users had experienced some vaginal bleeding, compared with 10% of DMPA users. Time to resumption of vaginal bleeding was related to the duration of DMPA use to the duration of DMPA induced amenorrhea, and to the body mass index of the user. Over the 6 months of follow-up, 94% of Cyclofem users complained of some side effects, compared with 22% of DMPA users. The most frequently cited problems among Cyclofem users included breast tenderness, abdominal pain, and dysmenorrhea; yet a third of these women opted to stay on Cyclofem at the end of the study. It is concluded that switching to Cyclofem is a new option for DMPA users who are concerned about amenorrhea. Although using Cyclofem in this setting will not meet the needs of all such women, its effectiveness in inducing vaginal bleeding justifies a trial in those who have no contraindication to estrogen treatment.

Adult↗
PubMed1992

Female condom launched in UK.

The lone-awaited female condom, Femidom, is to be launched at the end of September by manufacturers Chartex. It is being welcomed by the FPA [Family Planning Association] and other family planning experts as a valuable addition to the existing range of contraceptive methods and as an alternative to the male condom in offering effective protection against sexually transmitted diseases including HIV. A lubricated, loose-fitting polyurethane sheath, Femidom is inserted into the vagina at any time before sex. An inner ring holds the condom in place beyond the pubic bone and an outer ring lies flat against the vulva. In addition to extending choice, it is under direct control of the woman. As FPA Director Doreen Massey puts it: "We have to face the fact that some women who want safer sex can't get their partners to use condoms. for the 1st time with Femidom, you can insist that if he won't use a condom, you'll use yours." In trails of self-selected couples, up to 2/3 of women and their partners found the product acceptable. a study at the Institute of Population Studies in Exeter showed that while some couples had initial misgivings about the condom's size and appearance, especially its visibility when in position, these often declined with repeated use. Researcher Dr. Nicholas Ford pointed out that if the female condom makes a woman feel unattractive, her partner's comments may well influence these feelings. Users' experience of insertion and the condom's comfort also improved with repeated use. While there are no large studies showing ranges of effectiveness, it is likely to be as effective as the male condom (about 85%-98%). In a study of 106 women at the margaret Pyke Center in London, there were 7 unplanned pregnancies: 4 were due to inconsistent use of the method and 3 were method failures. Breakages were rare. 1/3 of participants dropped out in the 1st month. Users should continue with their existing contraceptive method until they are sure that they are using Femidom efficiently, recommended the authors. In October the FPA is launching a new free consumer leaflet on male and female condoms. 1/2 million leaflets will be distributed to UK pharmacies in October and November via the Pharmacy Healthcare Scheme as part of a safer sex campaign. a launch event will include the results of a survey asking pharmacists and consumers what they think of condoms.

Behavior↗
PubMed2001

Ovarian and endometrial function during hormonal contraception.

This report addresses the balance of benefits and risks from changes in ovarian and endometrial function from hormonal contraception. The main mode of action of hormonal contraception is inhibition of ovulation, due chiefly to the dose of oestrogen in combined oral contraceptives. With 20 microg dosages of ethinyl oestradiol follicular activity is more common so that contraception depends on suppression of the LH surge or disruption of the endometrial cycle. In polycystic ovary syndrome (PCOS) treated with oral contraceptives, cysts become smaller and in time the ovarian volume is reduced, ovarian testosterone secretion is reduced and there are potentially favourable effects on carbohydrate and lipid metabolism. Typical oral contraceptive users in the 1980s had a lower incidence of ovarian cysts, but modern oral contraceptives do not appear to affect the incidence of functional cysts or benign epithelial cysts. Moreover, randomized controlled trials indicate that oral contraception prescriptions are unlikely to prevent the development of functional cysts or to hasten their disappearance. Oral contraceptives, however, greatly reduce pelvic pain in women with symptomatic endometriosis and improve the health-related quality of life. Bleeding is a common response with all types of hormonal contraception, but current methodology is inadequate to make accurate comparisons of different products or of different phasic formulations. With continuing use, however, combined oral contraception is associated with endometrial atrophy, the biological plausibility for a reduced risk of endometrial carcinoma. With progestin-only contraception, a number of endometrial changes are considered as possible mechanisms of the associated bleeding but it remains largely unexplained. Oral contraceptives are frequently used for treatment of dysfunctional uterine bleeding, although only one trial has been reported. Oral contraceptive use confers protection from endometrial [relative risk (RR) 0.5] and ovarian (RR 0.4) cancers and in both cases, the protection lasts for up to 2 decades after stopping use.

Contraceptive Agents, Female↗
PubMed2002

Future trends in contraceptive prevalence and method mix in the developing world.

This study reviews existing methodologies for projecting future trends in contraception, evaluates the validity of the assumptions underlying these projections, proposes methodological improvements, and assesses the prospects for new methods of contraception in the coming decade. Demand for contraception can be expected to continue to rise rapidly for the next few decades as populations continue to grow and fertility declines to approach replacement level. As a result of these trends, the number of contraceptive users in the developing world is expected to rise from 549 to 816 million during the next 25 years, according to the most recent UN projection. An examination of the projection methodology found it to be reasonable. Projecting the future distribution of specific contraceptive methods is more difficult. Method choice is affected by trends in several factors, including access to different methods, user characteristics, and technology. The procedure employed by the Futures Group to project method mix was found to be less than optimally designed, and a new methodology is, therefore, proposed.

Contraception↗
PubMed1980

Keep or adopt: a study of factors influencing pregnant adolescents' plans for their babies.

The 1976 U.S. census lists 235.3 births for every 1,000 unmarried women below the age of nineteen [1]. From these figures it appears that in spite of the availability of contraceptive methods adolescent pregnancy continues to be a problem in this country. It is one problem that has always been of interest to mental health practitioners and fortunately various services are available which provide social, medical and educational support. Several facilities offer comprehensive care, but the services are usually confined to the time of pregnancy and two to three months following the birth. While such services seem appropriate for a large number of young women, for some, however, care is needed for a longer period.

Adolescent↗
PubMed1997

Oral contraceptives and breast cancer risk.

Because of the continuing controversy on the breast cancer risks associated with the use of combined oral contraceptives (OCs), the medical literature was reviewed to assess the risks of this cancer to OC users. This review found that the medical literature supports the view that OC use is associated with small increased risks of premenopausal breast cancer. There is no consensus as to which subgroups of women might be at an increased risk.

Adult↗
PubMed1984

[Histological reaction of the endometrium to irritation by a probe in relation to the problem of embryo transfer during in-vitro fertilization].

The purpose of this study was to try to explain morphologically why a high percentage of artificially inseminated embryos fail to implant after intrauterine transfer. To investigate the problem we irritated with a probe the endometria of 31 women of child-bearing age a few days before their scheduled hysterectomies. Our histological studies of the uteri were directed towards learning whether a localised decidual change had developed at the site of mechanical irritation. In addition, we measured the serum values of FSH, LH, prolactin, progesterone, beta-estradiol, and cortisol of 22 of the patients on the day of mechanical irritation of the endometrium and on the day of hysterectomy. At the time of probe insertion six patients were in the proliferative phase. In three the endometrium responded with a slight crowding of enlarged stromal cells in the region of mechanical irritation. In three it failed to respond. In five patients who had continued to take oral contraceptives until their hysterectomy the endometrium also showed no response. In twelve patients of 17 in the secretory phase we found a focal predecidual to decidual change of the stroma. The hormonal values of these women were within normal limits. In the remaining five patients we found a deficient secretory phase without any evidence of decidual change. The serum values of progesterone for these patients were low. The results allow us to suggest that the mechanical irritation from transfer of an in vitro fertilised embryo in the early secretory phase might induce a premature decidual change, which could inhibit implantation of the embryo.

Adult↗
PubMed1996

Emergency hormonal contraception usage in genitourinary medicine clinic attenders.

OBJECTIVE: To assess the indications for usage of emergency hormonal contraception amongst a population of London genitourinary medicine clinic attenders. METHODS: In a prospective study, 150 consecutive women receiving emergency hormonal contraception (EHC) were enrolled. The attending doctor completed a questionnaire of patient details and prescribed EHC with prophylactic prochlorperazine. Follow-up was arranged three weeks later, at which time outcomes and side-effects of therapy were recorded. For those women who did not reattended as planned case notes were reviewed at three months. RESULTS: Of 150 women surveyed, 100 (66%) reported contraceptive method failure, 48 (32%) had used no contraception at the time of last sexual intercourse and two requested EHC after sexual assault. Ninety three (62%) reported condom failure, 7 (5%) oral contraceptive pill failure. Seventy five (50%) had used EHC before (range 1-10 times). Seventy one (47%) women reattended within three months. Five (3.3%) of the 150 women were pregnant; none of these cases had experienced nausea or vomiting whilst taking EHC. Side-effects were reported by 22 (31%) of the 71 patients who reattended. Nine (6%) women had been followed-up in the family planning advisory clinic. Of the 71 women who reattended, 39 (55%) reported that their preferred future method of contraception would be condoms. Of the 150 women 19 (13%) underwent tests for sexually transmissible infections within one month of presentation. CONCLUSIONS: EHC usage in this population was associated with a failure rate of at least 3.3% and an overall side effect rate of 31%. Despite requests for emergency contraception because of condom failure many elected to continue using condoms as their preferred method of contraception. The majority of women (53%) did not return for follow-up or family planning advice, and so we believe that future contraceptive plans must be addressed at the time EHC is prescribed.

Adolescent↗
PubMed1997

Interval and postabortal contraception with the frameless GyneFix.

Intrauterine contraceptive devices (IUDs) have not suffered from the same negative influences in the developing world as in the first world. The method has too many basic advantages to be gainsaid including, most importantly, that it has the lowest lifetime cost of any effective method of contraception, and that user compliance is not an issue once the device is in place. However, the global community is not immune from trends that are seen in selected industrialized countries. Today, better methods of contraception are requested and the discomforts associated with earlier models of IUD, which were once acceptable, are less so today. Faced with the side-effects of oral contraception and the high cost in developing countries, many women who have completed their families undergo surgical sterilization as the only long-term method available to them, notwithstanding severe cultural and economic reservations about doing so. The development of the frameless device is a response to the growing need to develop high-performing, long-acting, reversible and acceptable contraceptives with a high continuation of use and to respond to the urgent need to reverse the legacy of neglect of immediate postabortal family planning.

Abortion, Induced↗