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PubMed1999

A combined surgical and radiologic technique for creating a functional neo-endocervical canal in a case of partial congenital cervical atresia.

OBJECTIVE: To recanalize the endocervical canal in a patient with partial congenital cervical atresia. DESIGN: Case report. SETTING: University hospital. PATIENT: A 16-year-old girl referred with a history of primary amenorrhea, polycystic ovaries, and intermittent abdominal pain. Physical examination revealed a normal vagina and external cervical os, but magnetic resonance imaging revealed a solid endocervical tract. INTERVENTION(S): At laparotomy the endometrial cavity was accessed transfundally and outlined by injection of water-soluble contrast. A trocar needle was guided transvaginally into the uterus, the tract was dilated, and a 12F stent was placed. Oral contraceptives (OCs) and antibiotics were continued postoperatively. MAIN OUTCOME MEASURE(S): Hysterosalpingography and clinical follow-up. RESULT(S): The operation and postoperative course were uneventful. Withdrawal bleeding occurred at 8 weeks, after discontinuation of the OCs, at which time the stent was expelled. Later follow-up revealed recurrent narrowing, and the stent was replaced for 14 more weeks. After stent removal, regular menses continued (7 months to date). CONCLUSION: In select cases of congenital cervical atresia, recanalization may be safely performed with the use of the combined surgical-radiologic technique described, with good short-term outcome.

Adolescent↗
PubMed2002

Reproductive hormones and cancer: ovarian and colon cancer.

Evidence continues to accumulate that oral contraceptive use provides substantial protection against ovarian cancer. Less clear is whether the benefit affects women with genetic predisposition or women in the perimenopausal age range. The role of hormone replacement therapy in the occurrence of ovarian cancer is unclear. Available evidence suggests that if there is any potential risk, it involves women who use estrogen alone. Few women if any entering the menopause are at risk. There is some evidence that oral contraceptives have a favorable impact on the risk of colorectal cancer. Available data are limited. Finally, there is growing evidence that hormone replacement therapy reduces risk of colorectal cancer, a benefit that accrues to perimenopausal women.

Colonic Neoplasms↗
PubMed2001

Women's reasons for discontinuing contraceptive use within 12 months: Jamaica.

In Jamaica, contraceptive use is high at 66 per cent. However, only 34 per cent of pregnancies are planned. This study was carried out in 1998 to determine the factors which influenced continuation of use of family planning methods. Primary data were collected from 463 mostly post-natal women utilising eight large clinics in the public health sector in Kingston, Jamaica. They were interviewed using a closed-ended questionnaire three times over a year and a sub-sample participated in focus group discussions. The overall continuation rate was only 56 per cent. Cost of methods was an issue for some women. Long clinic waiting times discouraged women from attending clinics; the scheduling of clinic appointments would reduce this problem. Women need more information about side effects of methods and to be reassured of the quality of methods given out by clinics. Health personnel need to become more aware of the significance of rumors about methods and discuss these with women so that the negative influence of misinformation is minimised. Although the findings of this study are not 'new' information, 'old' problems in the provision of services still exist. Women, at least in poorer communities, continue to lack basic information about contraceptives and there is a need for ongoing attention to improving quality of care.

Adolescent↗
PubMed2003

Cost-effectiveness of USAID's regional program for family planning in West Africa.

Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

Adolescent↗
PubMedDate not supplied

Consultation patterns and provision of contraception in general practice before teenage pregnancy: case-control study.

OBJECTIVES: To determine patterns of consultation in general practice and provision of contraception before teenage pregnancy. DESIGN: Case-control study, with retrospective analysis of case notes. SETTING: 14 general practices in Trent region. SUBJECTS: 240 registered patients (cases) with a recorded conception before the age of 20. Three controls per case were matched by age and practice. MAIN OUTCOME MEASURES: Consultations in general practice and provision of contraception in the 12 months before conception and recorded provision of contraception at any time before conception. RESULTS: Overall, 223 cases (93%) had consulted a health professional at least once in the year before conception, 171 (71%) had discussed contraception in this time, and 121 (50%) had been prescribed oral contraception. Cases were more likely to have consulted in the year before conception than controls (odds ratio 2. 70, 95% confidence interval 1.56 to 4.66). Most of the difference was owing to consultation for contraception. Overall, 53 cases (22%) resulted in a termination of pregnancy. Cases whose pregnancy ended in a termination were more likely to have received emergency contraception than either their controls (3.21, 1.32 to 7.79) or cases resulting in other outcomes (3.01, 1.06 to 8.51). CONCLUSIONS: Most teenagers who became pregnant attended general practice in the year before pregnancy, and many had sought contraceptive advice. The reluctance of teenagers to attend general practice for contraception may be less than previously supposed. The association between provision of emergency contraception and pregnancy ending in termination emphasises the need for continuing follow up of teenagers consulting for this form of contraception.

Adolescent↗
PubMed2004

FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception.

This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal antiinflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR).

Consumer Product Safety↗
PubMed1982

Cesarean section IUD insertion.

A trial was carried out on 154 selected volunteers who underwent cesarean section and then received an ML Cu 250 IUD during the operation. 56% of the operations were planned while 44% were not. The IUD was inserted in 65, 80, and 9 cases in the 1st, 2nd, and 3rd cesarean section, respectively. The patients were followed-up after 1, 3, 6, 12, and 24 months. Hospitalization time and postoperative morbidity did not increase with device insertion. Maternal lactation was not altered. 8% of the patients had postpartum bleeding which lasted more than 40 days. At the 1 year examination, 52% of the patients were menstruating normally while at 2 years, the percentage had increased to 62.5%. The acceptability, continuity, and efficiency of the contraceptive procedure proved successful. There were only 4 cases (2.6%) in which the device had to be removed for medical reasons (due largely to endometritis) and 8 cases (5.2%) because of patient desire (menstrual abnormalities). Spontaneous expulsion of the IUD occurred in 4 cases (2.6%). As of the present time, no pregnancies have been detected. The cesarean section insertion of an ML Cu 250 IUD produced excellent results and further, more widespread use is suggested.

Endometritis↗
PubMed1994

Family planning in Viet Nam: a vigorous approach.

Viet Nam, a country in transition, is vigorously implementing its population and family planning policies and plans, despite the fact that increased government expenditure for family planning only amounts to some US $0.15 per capita, far short of the minimum $0.60 required. An increased range of family planning methods will be offered to the population through a "cafeteria" approach. Genital tract infections will be reduced, as well as the incidence of abortion. Research continues on injectable and implanted contraceptives, and the use of quinacrine nonsurgical female sterilization. In the long term, a mix of imported and locally-produced contraceptives is envisaged to achieve greater sustainability. Family planning will be closely linked to economic development and poverty alleviation, with mass organizations developing family planning-linked credit, savings and income generating schemes. Pilot experience has indicated value if integrated approach linking family planning, nutrition, and parasite control. The health manpower and health services systems are being overhauled, with plans to appoint family planning focal points at commune level, linked to mobile district teams and grassroots motivators. Medical equipment, contraceptives and essential drugs for family planning and reproductive health services are in short supply at an estimated 60% of commune health stations. Both the public sector and the growing private sector will need to face the challenge of providing the population with high-quality reproductive health services and family planning options suited to individual needs and preferences.

Contraception↗
PubMed1977

Nine year follow-up of a case of benign liver cell adenoma related to oral contraceptives.

The case of a 26-year-old women on oral contraceptives who developed a benign liver cell adenoma that was successfully resected is reported. She continued on her oral medication and developed a recurrence 3 years later. On her second laparotomy, the liver tumor was merely biopsied and not removed. Oral contraceptive use was continued for an additional 3 years and then stopped. The tumor has regressed and is no longer palpable or diagnosable. The patient continues to be well 9 years following her first surgical procedure.

Adult↗
PubMed1975

The use-effectiveness of two contraceptive methods in a Navajo population: the problem of program dropouts.

Navajo Indian intrauterine contraceptive device (IUD) and oral contraceptive users between 1966 and 1971 were followed up to estimate life table rates of complications and continuation. Because of high rates of dropping out, 41.6 per cent of 291 oral contraceptive users and 18.2 per cent of 534 IUD users, a 26 per cent sample survey of the dropout population was used to collate the dropout population data into the life table analysis. Estimates of the IUD continuation rates for one, two, and three years are similar to rates published elsewhere; however, continuation rates for the oral contraceptive are clearly lower than those for other populations, which only 33 per cent continuing after one year, 23 per cent after two years, and 12 per cent after three years. The IUD user is two to three times more successful than the oral contraceptive user in this population.

Adolescent↗
PubMed2005

Contraception: an international perspective.

Although it is estimated that the population growth rate will decline to a replacement level by 2050, it is also now predicted that the total world population will reach 8.9 billion in that year -- far higher than the 2004 estimate of 6.4 billion. More than 26 billion new couples will need contraceptives in the next half century. Although a steady increase in contraceptive use has been observed in both developed and developing countries, the contraceptive needs of a high percentage of couples have not yet been met and the number of unplanned pregnancies continues to increase. The actual use of contraception differs from region to region. Although no new method has been registered for many years, several new products have been marketed during the last 5. Among these are new implants, medicated intrauterine systems, contraceptive vaginal rings, transdermal patches and several new combined oral contraceptive formulations. New contraceptive methods have been developed to meet the objectives of expanding contraceptive choices for both women and men and answering an unmet need for contraceptives with a long-term action that meet the expectations of consumers. Simplicity, reversibility and effectiveness are the desired features of a male contraceptive, but no new male contraceptive method is yet available. New areas of basic research include studies on genes, proteins and enzymes involved in the reproductive system. The new methods will be targeted to specific interactions within the reproductive system at the level of ovaries and testes, as well as between spermatozoa and ova. This futuristic approach still keeps in mind the need for better access to existing contraceptive methods, as well as the discovery of new contraceptives that are simple to use, safe, reversible and inexpensive. In the future, contraceptives may be combined with other medicinal agents to provide dual protection against both pregnancy and other preventable conditions, such as sexually transmitted infections.

Contraception↗
PubMedDate not supplied

Enhanced metabolism of levonorgestrel during phenobarbital treatment and resultant pregnancy.

Levonorgestrel implants (Norplant) are an alternative to oral contraceptives and medroxyprogesterone acetate intramuscular injections. An interaction may exist between levonorgestrel and agents that induce the hepatic microsomal enzyme system. A 21-year-old woman with a history of a seizure disorder, treated with phenobarbital, who received levonorgestrel implants became pregnant. After a normal delivery, she took oral contraceptives concomitantly with phenobarbital. Although she was educated about the importance of a backup method of contraception, the woman again became pregnant and delivered twins. A recent national survey of neurologists and obstetricians was conducted evaluating prescriber knowledge of interactions between oral contraceptives and anticonvulsants. Only 4% of neurologists and zero percent of obstetricians knew all the interactions between the six most commonly prescribed anticonvulsants and oral contraceptives. This case supports the importance of continued patient and prescriber education regarding the possibility of drug-drug interactions in women taking anticonvulsants and hormonal contraceptives.

Adult↗
PubMed1983

Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. Final report.

Final results are presented from a two-year WHO multinational comparative trial of three regimens: depot-medroxyprogesterone acetate (DMPA) given at 90-day intervals, norethisterone enanthate (NET-EN) given at 60-day intervals for the entire study period (NET-EN (60-day)), and NET-EN given at 60-day intervals for six months and thereafter at 84-day intervals (NET-EN (84-day)). 1587 DMPA subjects were observed for 20,550 woman-months, 789 NET-EN (60-day) subjects were observed for 10,361 woman-months, and 796 NET-EN (84-day) subjects were observed for 10,331 woman-months. This clinical trial represents the largest clinical trial undertaken on injectable contraceptives. After two years, the pregnancy rate with NET-EN (84-day) was 1.4 (+/- 0.6 S.E.) per 100 women, as compared with the two-year rates of 0.4 (+/- 0.3 S.E.) per 100 women observed with DMPA and 0.4 (+/- 0.2 S.E.) with NET-EN (60-day). Both discontinuation rates for amenorrhea and the prevalence of amenorrhea lasting more than 90 days were significantly higher with DMPA than with either NET-EN regimen. Terminations for bleeding problems were similar with the three treatments, despite a better cyclic pattern for the first six months with the NET-EN regimens. The three treatments were comparable with respect to discontinuation rates for other medical or personal reasons, and for all reasons combined. For family planning programs, NET-EN (60-day) has the advantage of low pregnancy rates compared to NET-EN (84-day), and a schedule of administration that does not change. Both NET-EN regimens produce less amenorrhea than DMPA. However, the NET-EN (60-day) regimen has the logistic and economic disadvantage of requiring more frequent injections. All three injectable regimens compare favourably with oral contraceptives in terms of pregnancy and total continuation rates observed in clinical trial settings.

Adult↗
PubMed1994

The effect of patterns of oral contraceptive use on breast cancer risk in young women. The UK National Case-Control Study Group.

The effect of the duration and pattern of oral contraceptive use on breast cancer risk in young women (aged under 36 at diagnosis) has been investigated. Oral contraceptive users were divided into three groups: group 1, continuous users; group 2, interrupted only by pregnancy users; and group 3, intermittent users. There was a clear trend with duration of oral contraceptive use in all three groups of users (P < 0.001 for each category of use) and the relative risks per year of use were similar (1.07, 1.07 and 1.05 in continuous, interrupted and intermittent users respectively). The relative risks for intermittent users and for women who had used oral contraceptives except when pregnant were very similar, but the relative risk for users for more than 8 years was highest for continuous users. The results suggest that the relationship between oral contraceptive use and breast cancer risk is dependent upon the total duration of use and is not modified by the pattern of use.

Adult↗
PubMedDate not supplied

Initial pill selection and managing the contraceptive pill patient.

Contraceptive pill risk may be lowered and patient continuation rates increased by selecting a pill best suited to each patient's needs. Each contraceptive pill has a unique profile of activity which is dependent upon both the dosage and type of progestogen and estrogen. Patient characteristics, expecially menstrual history, are helpful in choosing an initial pill (which should be low in estrogen), and patient and family histories are also valuable in helping determine whether use of the pill is contraindicated. Patients with a history of sensitivity to their own hormones are more likely to experience side effects on contraceptive pills, as also are underweight women. Knowledge of individual pill activities and potencies can be helpful in selecting the initial pill and in changing pills when nonserious side effects occur.

Adult↗
PubMed2001

[Hormonal contraception for adolescents].

The new hormonal contraceptives are safe, effective and with fewer side effects than the older formulations. Their incidence of serious complications is low, particularly as compared to the health risk related to pregnancy. Adolescents must be screened for contra-indications before giving them a hormonal contraceptive. Because pills do not prevent sexually transmitted diseases, teenagers should be counselled to use a barrier methods together with COCs. Young girls need frequent follow-up and close monitoring to minimise side effects and to increase compliance and continuation in use. Long-term contraception by implants represents a valid alternative option with an increasing popularity among adolescents.

Adolescent↗
PubMedDate not supplied

Hormonal contraception: what is new?

Hormonal contraception has become more effective and more widely used, while the world population has grown from 3000 million in 1960 to 6000 million in 2000. There is a need for improved contraception, because legal abortion is used in a high proportion of pregnancies and illegal abortion continues to be common in some countries. Hormonal contraception now includes different choices of administration and dose regimens. The best selection depends on the benefits and risks of the method and whether there is a medical disability. Medical eligibility for combined oral contraceptives has improved during the past 40 years so that, for most women, all currently available low-dose products are safe. For women with medical conditions, wider eligibility for oral contraceptive use has evolved from better knowledge of the risk factors. The long-term risks of rare cardiovascular and malignant adverse events remain controversial. There are long-term benefits, however, as oral contraceptive use appears to protect against endometrial, ovarian and colorectal cancers. Emergency contraception provides an option that reduces the number of unplanned pregnancies with little or no long-term risk. Endometrial contraception is an option that would ideally have no influence on ovarian function or the bleeding pattern, and cause no significant side-effects. Hormonal male contraception, with indirect suppression of spermatogenesis by decreasing gonadotrophin output, is a further choice. Although hormonal contraception is effective and safe, many research investigations remain to be carried out in order to improve tolerance and achieve wider utilization.

Contraceptive Agents, Male↗
PubMedDate not supplied

How the number of living sons influences contraceptive use in Menoufia Governorate, Egypt.

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.

Adolescent↗