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PubMed1992

Glutathione peroxidase activity in a healthy Canadian population. Effects of age, smoking and drinking habits, exercise and oral contraceptive use.

The activity of the enzyme glutathione peroxidase (SeGSHPx) has been suggested as an indicator of selenium status. The purpose of this study was to measure the activity of this enzyme in a large sample of healthy, free-living Canadians to determine normal distributions and the effects of age, smoking, and drinking habits, exercise, and the use of oral contraceptives (OCs) or estrogen replacement therapy. The population consisted of 386 self-selected subjects between the ages of 24 and 75. Erythrocyte SeGSHPx activity was 21.5 +or- 7 (Mean +or- SD) and 33.6 +or- 8U/g Hb and plasma activity was 226 +or- 31 and 214 +or- 38 U/L for males (n=239) and females (n=147), respectively. Erythrocyte activity was significantly higher in females and males (p0.01). The Se form of GSHPx accounted for 76% and 54% of total activity in plasma and erythrocytes, respectively. No differences due to age were seen in males, although plasma SeGSHPx, non-SeGSHPx, and total GSHPx activities were elevated in females 65 years of age and older. Cigarette smoking significantly elevated erythrocyte SeGSHPx and total activity in male subjects. This elevation did not vary with the amount smoked and was not seen in ex-smokers. Drinking elevated erythrocyte non-SeGSHPx and total activity in male subjects with the highest activity seen in drinkers who also smoked. No significant differences were seen with level of exercise except for a slight elevation with vigorous exercise. Estrogen use significantly elevated erythrocyte SeGSHPx, non-SeGSHPx, and total activities in both pre- and postmenopausal women. These data suggest that some lifestyle factors can have small but significant effects of GSHPx activity and must be controlled for when population-based surveys are being conducted.

Americas↗
PubMed1984

Disposition of clotiazepam: influence of age, sex, oral contraceptives, cimetidine, isoniazid and ethanol.

Factors influencing the disposition of clotiazepam in man were evaluated in a series of pharmacokinetic studies in healthy volunteers given a single 5 mg dose. Old age caused an increased volume of distribution of clotiazepam in women, and its clearance tended to be reduced in elderly men. Use of oral contraceptives, cimetidine, isoniazid or a single dose of ethanol had no significant effect on the kinetics of clotiazepam. Although clotiazepam is biotransformed by microsomal oxidation, its clearance appears to be relatively uninfluenced by factors known to alter the clearance of other oxidized benzodiazepines.

Adult↗
PubMedDate not supplied

How frequently is emergency contraception prescribed?

A 1993 survey of 294 reproductive health care providers, family practitioners and emergency room physicians investigated the frequency of prescribing emergency contraception. Hormonal emergency contraception had been prescribed by respondents an average of 3.4 times in the preceding 12 months. Almost one-third of the prescriptions were for rape victims, the majority written by emergency physicians. Fifteen IUD insertions for emergency contraception were performed in the preceding year. Few respondents had ever discussed emergency contraception with patients or had literature available on the topic.

Contraception↗
PubMed2000

Oral contraceptives and fatal pulmonary embolism.

In a national case-control study of fatal pulmonary embolism in New Zealand women of childbearing age, we estimated that current users of combined oral contraceptives had a relative risk of 9.6 (95% CI 3.1-29.1). From national distribution data, the absolute risk of death from pulmonary embolism in current users was estimated to be 10.5 per million woman-years.

Adult↗
PubMed2005

Target-oriented anti-implantation approaches for pregnancy interception: experiences in the rhesus monkey model.

Blastocyst implantation is a critical process in the establishment of pregnancy in eutherian mammals and requires a harmonious symbiosis between the developing conceptus and the differentiating maternal uterus. A better understanding of this symbiotic relationship will provide novel approaches and interventions for realizing anti-implantation strategies for effective fertility regulation and reproductive health care management. We have been using the rhesus monkey (Macaca mulatta) as a nonhuman primate model to this end. In the present study, the process of progesterone-mediated regulation of endometrial receptivity for blastocyst implantation has been targeted by the use of mifepristone as an emergency contraceptive agent. Furthermore, based on cell-specific, temporal and spatial distribution of vasotropic cytokines and mediators in the "receptive" and periimplantation periods, the pregnancy interceptive potentials of (a) monoclonal antibody (MAb) to leukemia inhibitory factor (LIF); (b) inhibitors of nitric oxide synthase [e.g., N6-nitro-l-arginine (l-NAME) and aminoguanidine]; and (c) MAb to vascular endothelial growth factor (VEGF) were examined. LIF is a progesterone-responsive pleiotropic cytokine that functions as a proinflammatory cytokine, together with interleukins 1 and 6, during the process of implantation-placentation in primates, and its immunoneutralization with MAb resulted in inhibition (p<.04) of pregnancy establishment in the rhesus monkey. However, timed administration of l-NAME or aminoguanidine failed to inhibit blastocyst implantation in a significant manner. Also, no synergistic antinidatory action of antiprogestin combined with l-NAME was detected in the rhesus monkey. The application of MAb to VEGF during the periimplantation period, on the other hand, led to significant (p<.04) prevention of pregnancy without influencing steroid hormone levels in the circulation. Our data lend support to the hypothesis that VEGF is essential for pregnancy establishment and that trophoblast-derived VEGF, acting via its specific receptors Flt-1 and KDR, is necessary for blastocyst implantation. The use of cDNA-based expression arrays followed by differential display analysis has provided preliminary understanding of the nature of gene cluster networks operative in the receptive endometrium of potential conception cycles in the rhesus monkey. This knowledge may, in the future, lead to further innovative anti-implantation strategies for targeted pregnancy interception.

Animals↗
PubMed1986

Five years' experience with levonorgestrel-releasing IUDs.

Two levonorgestrel-releasing IUDs and a copper-releasing IUD of the same shape were studied in a randomized comparative study over five years. The levonorgestrel-releasing IUDs released 20 micrograms or 30 micrograms per day. The Pearl index during the 10,600 woman-months of LNG-IUD use was 0.11. The control device releasing copper had a Pearl index of 1.6. The amount and duration of menstrual bleeding was greatly reduced, leading to a high incidence of oligo- or amenorrhea. The continuation rate in this pioneer trial was 53 per 100 users for the levonorgestrel-releasing IUD (LNG-IUDs) and 50 per 100 users for the copper-releasing IUD (Nova T). The removal rates for reasons other than amenorrhea were not significantly different. Discontinuation because of amenorrhea occurred during the first two years, the cumulative termination rate for this reason was 11.6 per 100 users at five years. The LNG-IUDs removed for investigation after five years of use revealed that the devices contained about 40 percent of the original load. The effective lifespan of the device has been demonstrated by this study to be five years; the residual steroid gives an additional safety period of two more years. The LNG-IUD is a highly effective reversible contraceptive method, which strongly reduced the amount and duration of bleeding. During the first two months there is scanty but frequent spotting which, like the high incidence of oligo- and/or amenorrhea, requires counselling of health personnel and women using LNG-IUDs.

Adult↗
PubMed1996

Oral contraceptive use and risk of breast cancer in middle-aged women.

The authors used data from a population-based, case-control study of breast cancer conducted among women residing in King County, Washington State, who were 50-64 years of age in 1988-1990, to examine the relation of oral contraceptive use to the risk of breast cancer. There were no clear differences between cases and controls with respect to the total duration of oral contraceptive use, time since last use, or age at first or last use. While a small increase in risk was noted in women who had first used oral contraceptives within 20 years of the interview reference date, within that period there was no trend in risk observed with decreasing amounts of time since the last use of these agents. Overall, this study supports the absence of any strong association between oral contraceptive use and breast cancer risk during middle age in the cohort of women who first used these drugs.

Age Distribution↗
PubMed2002

Contraceptive methods and risk factors of cardiovascular diseases in Tehranian women: Tehran Lipid and Glucose Study.

Combined oral contraceptive (COC) users were reported to be at high risk for vascular thromboembolism and cardiovascular diseases. This cross-sectional study was aimed at determining the prevalence of cardiovascular risk factors in COC users and non-users in Tehran in 1999. The subjects were 2480 married women aged 15-49 years among the 15 000 participants in the Tehran Lipid and Glucose Study. The method of contraception (COCs, intrauterine devices (IUDs), condoms or coitus interruptus) was determined by questionnaire. Blood pressure, height and weight were measured. A 12-14 h fasting blood sample was taken for the determination of serum glucose, cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Two-hour postprandial plasma glucose, after 75 g oral glucose, was measured. Coitus interruptus, COC, condom and IUD were used in 48, 11, 4 and 5% of the individuals, respectively; 32% used no contraception. Serum cholesterol, triglycerides, HDL and LDL rates were within normal limits in all groups. No significant differences were observed in blood pressure, cholesterol, triglycerides and LDL between COC users and non-users. The present findings reveal the safety of COC pills in a group of Tehranian women. We recommend usage of COC pills in these women with respect to the background and confounding factors.

Adolescent↗
PubMed2001

Female sterilisation through mini-laparotomy at Gondar College of Medical Sciences.

OBJECTIVES: To describe the socio-demographic characteristics and clinical course and follow up of clients who have undergone voluntary surgical contraception (VSC) through minilaparotomy (mini-lap) under local anaesthesia (LA). Also, to evaluate the safety and method satisfaction, so as to forward recommendations for method utilisation in the Ethiopian context. DESIGN: A case series design where pre- and post-operative conditions of clients coming for voluntary surgical contraception via mini-laparotomy were systematically analysed. SETTING: Department of Obstetrics and Gynaecology, Gondar College of Medical Sciences, Gondar, Ethiopia. SUBJECTS AND METHODS: Eighty two clients (median age of 33 years, range 25-40) who decided to use tubal sterilisation method of contraception from April 1993 to May 1995 were included in the study. A format prepared and distributed to VSC providing sites in Ethiopia by the Family Guidance Association of Ethiopia (FGAE) was used in collecting the necessary information, including informed consent of every client. MAIN OUTCOME MEASURES: Previous knowledge of contraceptive methods, decision making for tubal sterilisation, size of incision, advantages of use of local anaesthesia in the local setting, duration of hospital stay, conditions on follow up. RESULTS: Eighty two (55.4%) women underwent tubal sterilisation through mini-lap. The mean number of the live children per client was 6.2 +/- 1.7, with parity ranging from two to eleven children. Mothers with five or more children were 70 (85.4%). Among 69 mothers (84.1%), the last pregnancy outcome were live births. The average length of the time since making a decision not to have any more children was 2.5 +/- 2 years (median of one year). The rationales given were economic, ill health and completed family size. Regarding the pattern of decision making, in 77 (91.9%) clients both the couples were involved in decision making. All except two underwent the procedure under LA and no complication was encountered during surgery. Follow-up attendance was 100% in one-year period and nothing serious was reported. All reported to be satisfied with the method. CONCLUSION: The study showed that early decision making by involving both couples other than proper case selection minimises regrets. The authors believe that tubal sterilisation through mini-lap under LA is an ideal method in developing countries where access to family planning and other reproductive health services are not widely available and where there is population explosion, less than 10% contraceptive prevalence rate and high maternal mortality.

Adult↗
PubMed1995

Epidemiology of endometrial neoplasia.

Though among U.S. women endometrial cancer is the most common invasive gynecological cancer, it has a relatively favorable prognosis. From 1986-1990, approximately 19% of U.S. Surveillance, Epidemiology and End Results (SEER) Program cases were diagnosed in women less than 55 years of age; however, the age-specific incidence (per 100,000) peaked at 70-74 years (100.7), which was 2.85 times the rate reported at 50-54 years (38.9). The incidence under 50 years was 2.19 times higher in U.S. White compared with U.S. Black women; for uterine corpus cancers diagnosed at 50 years and older, the ratio declined but continued to be elevated in Whites (1.46). In contrast, average annual age-adjusted mortality (per 100,000) from 1986-1990 for uterine corpus cancer (1970 U.S. standard) was almost twice as high in U.S. Black women (6.0) as in U.S. White women (3.3). The determinants of age-specific elevated risks in mortality, in contrast to the lesser age-specific risks in incidence experienced by U.S. Black women compared with U.S. White women, may be explored with respect to socioeconomic and cultural factors that influence the distribution of epidemiologic risk factors such as reproductive history, choice of contraception methods, hormone replacement therapy, obesity, and dietary factors; age-specific prevalence of hysterectomy for other gynecological conditions; quality of medical care and surveillance practices; genetic factors influencing susceptibility; and tumor-associated biological factors. The majority of risk factors and medical conditions associated with endometrial cancer are related directly or indirectly to the levels and metabolic effects of the reproductive hormones, namely estrogens and progestogens. The molecular, genetic and epidemiologic characterization of endometrial cancer is attempting to delineate the multiple steps in the natural history of estrogen-induced or estrogen-responsive neoplasms.

Black or African American↗
PubMed1983

Trials with the FEMCEPT method of female sterilization and experience with radiopaque methylcyanoacrylate.

A previous report described the development of a blind method to deliver methylcyanoacrylate (MCA) transcervically. Using 0.6 ml of a stable MCA whose polymerization time was closely controlled, we reported a 78% bilateral tubal closure rate in 23 cases with hysterosalpingographic control. Subsequent to the previous report, we initiated a study in which patients were randomly assigned to one of three treatment groups: a single MCA injection, a single MCA injection after uterine lavage, or two MCA injections 1 month apart. In addition, a radiopaque MCA has been developed with which it is possible to determine tubal entry after its application by means of the FEMCEPT device. Patients treated with radiopaque MCA have been studied to determine whether it is possible to predict tubal closure on the basis of tubal entry and distribution patterns. The results of these studies and their implications for contraceptive effectiveness of the FEMCEPT/MCA system will be reported.

Clinical Trials as Topic↗
PubMed1995

Fertility and family planning in African cites: the impact of female migration.

This study uses data from thirteen Demographic and Health Surveys to examine effects of female migration on fertility in African cities. Contrary to expectations, migration from villages and towns in the 1980s and 1990s reduced total fertility rates in African cities by about one birth, from an estimated average of 5.55 in the absence of migration to 4.59. New arrivals experience much lower fertility in their first few years in cities than long term residents of similar age and parity. This results from the initial unmarried status of most migrants, high levels of spousal separation among new arrivals who are married, dramatic increases in use of modern methods of contraception after 2 years in cities, and continuation of traditionally long durations of postpartum abstinence. Accommodation of additional migrants thus appears consistent with efforts to reduce fertility in cities. Moreover, prospects for increased contraceptive prevalence in Africa may depend heavily on changes in population distribution that influence the demand for children, specifically movement to cities.

Africa↗
PubMed1975

An epidemiological study of recent trends in ectopic pregnancy.

Data from two independent sources in England and Wales, the first based upon persons discharged from hospital and the second upon general practitioner consultations, indicate that the incidence of ectopic pregnancy has been increasing since the late 1950s, with a particularly sharp increase since 1970. Time trends in the age and regional distribution of ectopic pregnancy suggest that the increasing use of intrauterine contraceptive devices may be a major factor contributing to this recent increase in extrauterine gestations. In contrast, recent age and regional trends in tubal infection appear to be unrelated to the trends in ectopic pregnancy. The possible contribution of progestogen-only contraceptives, induced abortion and tubal surgery to the recent increase in extrauterine pregnancy cannot be assessed from the available data.

Abortion, Induced↗
PubMed1990

A simplified methodology for the community-based assessment of breast-feeding and amenorrhoea in Mexico.

Reported is the use of a simplified methodology for carrying out a community-based epidemiological assessment that is compatible with the goals of primary health care research. For this purpose, a current-status life table analysis of data from 1131 women who were served by community health workers in the State of México was used to determine the distributions of the duration of postpartum breast-feeding, amenorrhoea, and contraceptive use. The field methods used incorporated quality assurance procedures. At 1 month postpartum, 78% of the infants were still being breast-fed, at 5 months 50%, and at 12 months 25%. The level of amenorrhoea at 1 month postpartum was 85%, at 3 months 50%, and at 5 months 25%. Use of contraceptives was initiated at an early stage, with 42% of all users beginning during the first month postpartum. The simplified method described permitted the area's primary health care administrators to carry out research projects for programme development rapidly and was compatible with the locally available resources.

Adult↗
PubMed2003

Married women's satisfaction with their choice of contraception.

Fertility reduction has been promoted in Taiwan for almost 40 years. However, little research has been done into women's satisfaction with the methods of contraception they use. The purpose of this study is to explore their level of satisfaction, along with the related factors of demographic data, giving birth and types of contraceptives used. Employing a cross-sectional design, self-administered questionnaires were distributed to women in the northern area of Taiwan. Purposive sampling was used to collect data from 97 women. The results reveal a mean age of 37.21 years. The mean length of marriage was 13.53 years. The majority (43.29 %) of the subjects were graduates of high school or vocational school. Of the subjects, 92.78 % had given birth, while 35.05 % had experienced abortion. IUDs (Intrauterine Devices) were the most commonly used form of contraceptive, while 63.92 % used other types. Satisfaction was divided into four categories: satisfaction with contraceptive services, satisfaction with contraceptive knowledge source, satisfaction with contraceptive experience and satisfaction with spousal support. Overall, subjects were happy with the contraceptive methods they used. There was no statistical difference in satisfaction between demographic variances, fertility or contraceptive methods applied. Though subjects showed satisfaction with contraception, we feel women's subjective experiences should be investigated in order to promote even better satisfaction. Possible future studies could include random sampling and an examination of the related factors of contraceptive satisfaction.

Adult↗
PubMed1987

Ovulation detection following removal of levonorgestrel subdermal contraceptive implants.

The time to resumption of ovulation following the discontinuation of levonorgestrel subdermal implants (Norplant) was assessed in 10 women. A blood sample (2 ml) was taken at the time of Norplant removal and then twice weekly until the first evidence of ovulation (serum progesterone concentration greater than or equal to 5 ng/ml) was documented. Ovulation was resumed in 80% of the cases by 3 weeks and in all the cases by 7 weeks. Prompt return of ovulation following Norplant removal is an additional advantage of this mode of long-acting contraception.

Adult↗
PubMed1989

[Disseminated peritoneal leiomyomatosis. A rare disease picture].

After taking oral contraceptive hormones continuously for 17 years, a 44 year old patient developed enlarging uterine leiomyomas and multiple small to tiny subperitoneal nodules throughout the pelvic peritoneum. Histologically and immunohistochemically, the nodules proved to be leiomyomas. Similar nodules were induced in young female guinea pigs by injecting them with estradiol twice weekly. The first nodules appeared after four months. Approximately 50 cases of Leiomyomatosis peritonealis disseminata (LPD) have been reported to date in the world literature. Of these, 23 patients were pregnant. Seventeen had taken oral contraceptives continuously for many years (from 8-17). The developing leiomyomatous nodules probably arise from the Müllerian epithelium, which is distributed throughout the subperitoneal mesenchyme. By appropriate individual predisposition and excessive hormonal stimulation, the Müllerian derivatives proliferate along lines of myofibrous differentiation. Since the oral contraceptives all contained in addition to estradiol the synthetic gestagen norethindrone (or lynestrenol) and since these same hormones led to identical tumor nodules in animal experiments, it seems to suggest, that the stimulation of the Müllerian epithelium results from a specific combination of hormones. A similar combination of hormones may develop endogenously during a hormonally disturbed pregnancy. To prove these assumptions, larger case and interdisciplinary studies are needed. It is of clinical importance to realize, that the dormant Müllerian epithelium may be stimulated by excessive hormones to proliferate and that the proliferations produced, such as the benign nodular tumors of LPD, must be differentiated from nodular metastases of malignant tumors.

Adult↗