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PubMed1996

The use of nomegestrol acetate subdermal contraceptive implant, uniplant, during lactation.

Uniplant is a single contraceptive implant intended for one year use. It contains the progestogen nomegestrol acetate. The clinical performance and the effect of its use during the first postpartum year on breastfeeding performance and growth and health of the infants were studied and compared to the findings in a parallel group who used an intrauterine contraceptive device (IUD) in a prospective, non-randomized study. This was carried out in Assiut, Egypt. Two-hundred-forty fully breastfeeding mothers asking for initiation of contraception early postpartum were assigned according to their choices into either nomegestrol subdermal contraceptive implant (Uniplant) (120 women) or intrauterine contraceptive device (CuT 380A) (120 women). The mother and infant pairs were followed up at monthly intervals during the first three months and at two-month intervals thereafter up until the first birthday of the baby. No pregnancy occurred in the two groups. Amenorrhea was significantly more prolonged in the Uniplant group than in the IUD group. There were no significant differences in net continuation rates between the two groups (88.3 versus 92.4 per 100 women, respectively). There were no significant differences between the two groups in the number of breastfeeding episodes, time of weaning, and the cumulative rates of full and partial breastfeeding. There were no significant differences between the two groups in infant weight, weight gain per day, or in infant linear growth. There were no significant differences in the incidence of important health problems affecting the infants of the two groups. However, there were seven infant deaths, six of them were in the Uniplant group. Uniplant subdermal contraceptive implants can be offered as a new contraceptive option suitable for nursing mothers.

Adult↗
PubMed1998

A scenario study of oral contraceptive use in Japan. Toward fewer unintended pregnancies.

A scenario study was conducted to assess the extent to which the unintended pregnancy rate in Japan, where oral contraceptives (OC) have not been legalized for family planning purposes and couples rely mainly on condoms, might change if more women were to use OC. Because current rates of unintended pregnancy and abortion in Japan are not known, data provided by the 1994 Japanese National Survey on Family Planning were used to construct scenarios for national contraceptive use. Annual failure rates of contraceptive methods and nonuse were applied to the contraceptive use scenarios, to obtain estimates of the annual number of contraceptive failure-related pregnancies. Subsequently, contraceptive practice situations assuming higher OC use rates were defined, and the associated change in the number of contraceptive failure-related pregnancies was estimated for each situation. It emerged that OC use rates of 15% decreased the expected number of unintended pregnancies by 13%-17%, whereas use rates of 25% resulted in decreases of 22%-29% and use rates of 50% in decreases of 45%-58%. The findings were reasonably robust to variation in the assumptions that were made. In conclusion, each theoretical percentage increase in the OC use rate in Japan was found to lead to a roughly equivalent percentage decrease in the number of unintended pregnancies.

Adolescent↗
PubMed1998

Effects of oral contraceptives on free fatty acid metabolism in women.

These studies examined whether women using oral contraceptives have abnormalities in free fatty acid (FFA) metabolism compared with women not using oral contraceptives. Plasma palmitate kinetics ([3H]palmitate) were measured at rest, following glucose ingestion, and during epinephrine infusion in 13 oral contraceptive users and 13 matched women not using oral contraceptives. Oral contraceptive users had significantly greater plasma triglyceride concentrations and glucose responses to oral glucose tolerance testing. No differences in basal (2.1 +/- 0.1 v 1.8 +/- 0.2 micromol x kg fat-free mass x FFM(-1) x min[-1]), glucose-suppressed (0.6 +/- 0.1 v 0.5 +/- 0.1 micromol x kg FFM(-1) x min[-1]), or epinephrine-stimulated (3.3 +/- 0.1 v 3.6 +/- 0.2 micromol x kg FFM(-1) x min[-1]) palmitate flux were detected between women using and not using oral contraceptives. The respiratory quotient (RQ) also was not different between groups. We conclude that the increase in plasma triglycerides and the mild glucose intolerance seen with oral contraceptive use is not associated with significant abnormalities of FFA metabolism.

Adult↗
PubMed2004

Male contraception--quo vadis?

Recent developments in the regulation of fertility have taken place mainly within female contraception. New hormones and forms of their application are being regularly introduced. The concept of male hormonal contraception is decades old. However, until very recently, little effort has been spent trying to develop this new form of contraception for the market. Condoms and vasectomy are widely used despite their shortcomings. This reflects the willingness of male partners to share the responsibility of contraception. Condoms offer good protection from sexually transmitted disease and will therefore not be fully replaced by other forms. However, development of reliable male hormonal contraception is important in offering more choice for men and couples when choosing long-term contraception, particularly in cases where female contraception presents significant side-effects or other problems.

Contraception↗
PubMed1983

The male role in contraception: implications for health education.

Today most contraceptive efforts are focused on the female. The resultant diminished male role may have inadvertently undermined the many societal efforts at birth control. Many men, young and old, still perceive contraception as primarily a woman's responsibility, for after all, she suffers most directly from contraceptive failure. This attitude is unfortunate. Since decisions about pregnancy affect both partners, both should share the contraceptive burden equitably. More specifically, the two-fold purpose of the paper is: (1) to examine the available male contraceptives; and (2) to draw implications of the changing male role in contraception for health professionals in the school and community. The paper argues that while the involvement of men in contraception will not automatically solve the problem of unwanted pregnancy among the young, it can certainly make a difference--an important difference.

Adolescent↗
PubMed1996

Contraceptive practice and attitudes in Sweden 1994.

OBJECTIVE: To investigate current contraceptive practice in Sweden and Swedish women's attitudes towards various contraceptive methods. METHODS: In 1994, a random sample of Swedish women (n = 2330), aged 15-45 years (stratified according to age and geographic distribution), were invited by telephone to participate in the study. Women (n = 1788) who accepted the invitation to participate were sent a postal questionnaire. RESULTS: Completed questionnaires were returned by 1422 women (overall response rate: 61.0%). The sample was somewhat skewed towards higher educational level, but in other demographic respects no great deviations from the parent population were observed. The distribution of contraceptive methods in fertile, sexually active women who wished to avoid pregnancy was as follows: oral contraceptives (OCs) 33%, OC plus barrier method 5%, intrauterine device 21%, barrier methods 23%, sterilization 5% (female 3%; male 2%) and injectable steroids 2%. The overall pattern of contraceptive use in women aged 15-45 years had changed very little compared to results of a similar survey performed in 1987. However, the use of less effective methods (periodic abstinence, coitus interruptus and no method grouped together) was considerably lower among teenagers in 1994 (3%) than in 1987 (18%). The use of these traditional methods was still high in women aged over 35 years (15-17%). A large number of women considered medical methods of contraception to be reliable and easy to use but many were concerned about the safety for health of medical methods. CONCLUSIONS: Contraceptive practice changed towards more frequent use of medical, effective methods among young Swedish women, but not in the total female population. The latter was among others related to the relatively high use rates of less effective methods among women aged over 35. Women were concerned about the health safety of medical methods and relatively low percentages of women reported having received advice from health care professionals to use effective methods.

Adolescent↗
PubMedDate not supplied

Current concepts in contraception.

BACKGROUND: Worldwide, contraceptive use has increased substantially over the past two decades. The increased demand for wider choices of contraceptive methods has resulted in extensive research and rigorous clinical trials. This has led to improvements on existing contraceptive methods and also the development of several new, more effective and acceptable methods with fewer side effects. Thus, this article presents a review of existing literature on recent developments on existing contraceptive methods. It also reviews recently developed contraceptive methods currently in use worldwide. METHODS: Relevant literature was reviewed using manual library search, electronic sources such as CD-ROMS and internet articles. CONCLUSION: More effective methods of contraception which are generally safer and easier to administer are increasingly being developed. Hopefully, as they increasingly become available in our environment, they will lead to and increase in acceptance and use of contraception by our women.

Contraception↗
PubMed1994

A decade of change in contraceptive behaviour in Latin America: a multivariate decomposition analysis.

This study relies heavily on World Fertility Survey and Demographic and Health Surveys data to examine recent trends and determinants of contraceptive use in five Latin American countries: Colombia, Dominican Republic, Ecuador, Mexico, and Peru. These countries experienced a substantial increase in contraceptive prevalence in the inter-survey period. Within countries, however, the increase was not equally shared by all social and demographic groups. The study found that relatively disadvantaged groups experienced greater gains in contraceptive use. Despite the prevailing tendency towards convergence, wide differentials in contraceptive behavior among social sectors still persist. A decomposition analysis based on logistic regression revealed that certain shifts in the population composition--i.e., increased proportion of urban and better educated women and a growing proportion of mothers who want to discontinue child-bearing--contributed substantially to the aggregate increase in contraceptive prevalence in most countries. Structural changes, understood as changes in the relations between the explanatory variables and the likelihood of using contraception, were also found to play a significant role in contraceptive use trends, particularly in Colombia.

Birth Rate↗
PubMed2005

Male contraception: expanding reproductive choice.

The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.

Androgens↗
PubMed1991

[Use of contraception among women applying for abortion].

During a period of one year (1988-89), a questionnaire was distributed to women applying for legal abortion at Frederikssund Hospital in Denmark. Two hundred and eight-eight answered the questions about why they had become pregnant. 84% of the women had used contraceptive methods. The remainder included women who regretted a planned pregnancy and women who believed they were infertile. 50% of the women had at least one intercourse without using contraceptives. Women using barrier-methods who forgot the contraceptive once or women who had stopped using the pill were mainly concerned. 23% of the women said they had used contraceptives correctly and consistently. After the abortions 75% intended to use IUD, oral contraceptives or sterilization. Suggestions to reduce the number of unwanted pregnancies are discussed. Eg. spread of the knowledge of postcoital contraception as an extraordinary measure after an unprotected coitus is suggested. This will not replace other contraceptives, but should be used in a emergency.

Abortion Applicants↗
PubMed1997

Emergency contraception: a second chance at preventing adolescent unintended pregnancy.

Adolescent pregnancy challenges the United States and Europe. For most sexually active adolescents, pregnancy is unintended. Emergency contraception, also called the "morning-after treatment" or postcoital contraception is a way to prevent pregnancy after unprotected intercourse. In February 1997, the Food and Drug Administration (FDA) approved the use of certain oral contraceptive pills for emergency contraception. There are currently six brands of pills marketed in the United States that can be prescribed to, conform to the FDA-approved regimen. When emergency contraceptive pills are initiated within 72 hours of unprotected intercourse, they reduce the risk of pregnancy by 75%. Contraindications are the same as those used for ongoing contraceptive pills. The most common side effects are nausea, vomiting, menstrual disturbances, breast tenderness, abdominal cramping, dizziness, headache, and mood changes. Routinely counseling all adolescents about emergency contraceptive pills and increasing access to them can give adolescents a second chance at preventing pregnancy.

Adolescent↗
PubMed2005

Hormonal contraceptive use, pregnancy and parity, and the risk of cervical intraepithelial neoplasia 3 among oncogenic HPV DNA-positive women with equivocal or mildly abnormal cytology.

Oral contraceptive (OC) use, hormonal contraceptive use and multiparity are potential risk factors for cervical precancer, cervical intraepithelial neoplasia 3 (CIN3), but a limited number of studies have adequately accounted for possible confounding effect of oncogenic human papillomavirus (HPV) infection. To examine the relationships of these factors with CIN3, we conducted an analysis of women (n = 5,060) with minimally abnormal Pap smears who were enrolled in the ASCUS and LSIL Triage Study (ALTS), a clinical trial to evaluate management strategies. Cervical specimens collected at enrollment were tested for HPV DNA using 2 methods. Multivariate logistics regression models were used to assess associations (odds ratio [OR] with 95% confidence intervals [CI]) of the potential risk factors (e.g., OC use and parity) with testing oncogenic HPV positive among controls (<CIN2) (n = 4,114) and with rigorously reviewed cases of CIN3 identified throughout the study (n = 499) among women with oncogenic HPV (n = 3,126). Only former oral contraceptive use (OR = 1.3, 95% CI = 1.0-1.7) was associated marginally with having an oncogenic HPV infection among controls. Restricted to women with oncogenic HPV, current injectable hormonal contraceptive users were at an elevated risk of CIN3 (OR = 1.6, 95% CI = 1.2-2.1) compared to women who never used them. Similarly, restricted to women with HPV16 infection, current users of injectable contraceptives were at a marginally elevated risk of CIN3 (OR = 1.5, 95% CI = 1.0-2.3) compared to women who never used them. Oral contraceptive use, Norplant (implantable hormonal contraceptive) use, a history of pregnancy, age at first pregnancy, lifetime numbers of pregnancies and lifetime numbers of live births were not associated with CIN3. We conclude that only current injectable hormonal contraceptive use slightly elevated the risk (approximately 50%) of CIN3 in this young and low parity population of women with oncogenic HPV and minimally abnormal Pap smears but further confirmation of this relationship is needed.

Contraceptive Agents, Female↗
PubMed2005

Over-the-internet availability of hormonal contraceptives regardless of risk factors.

OBJECTIVE: The purpose of this study is to measure the accessibility to purchase oral and transdermal contraceptives over the Internet for low- and high-risk individuals. METHODS: The Internet was used to search for and order both oral and transdermal contraceptives. Using the "Google" search engine to locate online pharmacies by entering the term "purchase contraception," we proceeded to purchase either oral contraceptives or contraceptive patches without a prescription. We first posed as a healthy 25-year-old woman, then as a 35-year-old woman who was obese and a heavy tobacco user, and finally, as a 35-year-old smoker on an antihypertensive medication. RESULTS: Our attempts to order both combination oral contraceptives, as well as contraceptive patches, over the Internet without a prescription were successful for all three risk profiles. We ordered from three different Web sites, two within the United States and one international site. The two U.S. Web sites required us to complete a medical questionnaire to obtain a prescription from the site provider, but the foreign site had no questionnaire or risk information posted on the Web site. Despite entering known risk factors for estrogen use, we received all the medications. There was no medical follow-up to these sales except for offers to sell more products. CONCLUSIONS: Both oral and transdermal contraceptives are easy to obtain over the Internet without a physical appointment with a health care provider to obtain a prescription.

Administration, Cutaneous↗
PubMed2006

Turkish adolescents' knowledge on and attitude toward emergency contraception.

OBJECTIVE: Adolescents tend to be at risk for unwanted pregnancies, so detecting their level of knowledge on emergency contraception and providing them information is important to prevent such pregnancies. Hence, in two faculties at Gazi University, this study aimed to detect freshman students' level and need of knowledge on emergency contraception and to evaluate their attitude towards emergency contraception. MATERIALS AND METHODS: The study was performed with freshman students of the Occupational Education Faculty and the Technical Education Faculty. A questionnaire including questions about demographic properties, obstetrical history, status of contraceptive use, level of knowledge and opinions on emergency contraception was administered to the students. Data was analyzed statistically with the computer program EPI Info 6.0. RESULTS: A total number of 385 adolescents were included in the studys; 157 of whom were males (40.8%) and 228 of whom were females (59.2%). To the question "is there any way to prevent a possible pregnancy after an unprotected sexual intercourse?", 166 students replied "yes" (50.5%), 39 "no" (11.9%) and 124 "I do not know" (37.7%). Of 166 students replying "yes," 114 (68.7%) listed a possible contraceptive method. The mostly cited method was "morning after pills" (n = 62; 54.4%), followed by curettage (n = 15; 13.2%). Among all students, 158 (49.8%) informed us that they were aware of the presence of "morning after pills" whereas 159 (50.2%) claimed they were not. Eighty-six male students (70.5%) and 115 female students (72%) emphasized that they would use emergency contraception upon necessity. CONCLUSION: Half of the participants were familiar with various options to prevent pregnancy after an unprotected sexual intercourse episode, but they lacked specific knowledge about possible methods and ways to use them. Thus, it is essential that information about emergency contraception be included in adolescents' educational programs and that adolescents be provided with easily accessible medical services.

Adolescent↗
PubMed2006

The impact of antiepileptic drug therapy on steroidal contraceptive efficacy.

Women with epilepsy face unique challenges in maintaining steroidal contraceptive efficacy because some antiepileptic drugs (AEDs) increase the rate of hepatic metabolism of contraceptive steroids, leading to higher potential for contraceptive failure in this population. Planned pregnancy is of great clinical and social importance for women with epilepsy because of the increased risk of birth defects from fetal exposure to AEDs. Current clinical guidelines for contraceptive management in women with epilepsy provide misleading information by focusing on the estrogen content of the formulation, which regulates the menstrual cycle, rather than on the progestin content of the formulation, which provides contraceptive efficacy. This article reviews studies of AED-contraceptive interaction and misconceptions about maintaining contraceptive efficacy and makes recommendations for contraceptive management in women with epilepsy who receive concomitant AED therapy.

Anticonvulsants↗
PubMed1999

Avoiding unwanted pregnancy--the role of communication, information and knowledge in the use of contraception among young Norwegian women.

Despite relatively easy access to contraceptives, a liberal attitude to pregnancies out of wedlock and a widespread family planning education in schools, too a high number of adolescent women in Oslo, the capital of Norway, become pregnant and resort to abortions. The aim of this study was to identify some new entry points to sexuality, contraceptive, abortion and post-abortion counselling. Using a qualitative approach, we interviewed 102 young women in Oslo who were seeking either an abortion or contraceptives. The study demonstrated that contraceptive awareness is good, but that there are different levels of consistency in contraceptive use among women, and that even women with few partners and fairly good contraceptive compliance sometimes experience unplanned pregnancy. The study reviews some issues of importance where communication with young women could be improved. These issues include better formal information about OCs, increased information on emergency contraception, better condom promotion, and an attempt to involve better informed adults, including paramedical professional counselling. In addition, contraceptive prescriptions should accord to the type of behaviour and the relationships the young women have.

Adolescent↗
PubMed2003

Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: implications for prevention of repeat pregnancy.

PURPOSE: To describe patterns and changes in contraceptive use among pregnant adolescents in early and later postpartum compared with nonpregnant adolescents. METHODS: One-hundred-seventy-six pregnant and 187 nonpregnant adolescents, recruited through community clinics, were interviewed three times (baseline, 6-month follow-up, 12-month follow-up) about their condom and hormonal contraceptive practices. Changes in contraception use and patterns of consistent hormonal and/or condom use were examined. Statistical analyses included General Estimating Equations (GEE) and multinomial regression. RESULTS: Pregnant adolescents increased hormonal contraceptive use from baseline to early postpartum, but decreased use from early postpartum to late postpartum. Nonpregnant adolescents did not change their hormonal contraceptive use over time. Neither group changed condom use over time. Pregnant adolescents were more likely to be consistent dual users and hormonal-only users during the 6-month follow-up compared with nonpregnant adolescents. These findings persisted at the 12-month follow-up, although there was a decline in hormonal contraception use. CONCLUSIONS: Adolescents change their contraceptive use during the postpartum period. Given the slight decline in contraceptive use in late postpartum in this sample, more work is necessary to maintain motivation to continue these positive postpartum trends.

Adolescent↗
PubMed2000

Effects of hormonal contraceptives on the periodontium, in a population of rural Sri-Lankan women.

AIMS: Women using hormonal contraceptives can be considered to be a 'risk group' for periodontal disease, due to prolonged, sustained serum levels of oestrogens and progesterone. This investigation aims to study the effects of hormonal contraceptives on periodontal tissues. METHODS: 32 women using hormonal contraceptives for less than 2 years, 17 for 2-4 years and a matched control group of 39 non-users were selected for the study. They were clinically examined for plaque levels (plaque index: PLI), gingival condition (gingival index: GI) and loss of periodontal attachment (LA). RESULTS: Contraceptive users of less than 2 years and 2-4 years duration (n=32, n= 17 respectively) and non-users (n=39) had similar oral hygiene levels; yet the contraceptive users had a significantly higher level of gingival inflammation, compared to the non-users (p<0.001; 1-way ANOVA). Usage of hormonal contraceptives for 2-4 years (n= 17) caused a significantly higher LA (p<0.001) compared to that of controls (n=39). CONCLUSIONS: Usage of contraceptive preparations containing oestrogen and progesterone resulted in hormonal changes similar to those seen in pregnancy, associated with increased prevalence of gingivitis. There was significantly higher LA with prolonged usage of hormonal contraceptives, compared with controls.

Adolescent↗