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PubMed1992

Future directions in contraception.

Although contraceptive research has markedly decreased in the United States, it has continued in other countries. The emphasis has been on the development of long-acting, noncoitally related contraceptives, including the progestogen-only and progestogen-estrogen vaginal rings. The levonorgestrel-releasing intrauterine device is highly effective and, like other contraceptives, may contribute to a decrease in the incidence of pelvic inflammatory disease. There is a great need for more effective, acceptable barrier contraceptives. The vaginal condom does not appear to be acceptable to many couples. Studies continue to demonstrate couples' lack of adherence to plans for abstinence and poor utilization of the present barrier contraceptives. The potential for the development of a male contraceptive utilizing gonadotrophin hormone-releasing hormone agonists or antagonists in conjunction with testosterone may hold promise in the future.

Contraception↗
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↗
PubMed1984

Prolonged elevation of hypothalamic opioid peptide activity in women taking oral contraceptives.

To examine the hypothesis that endogenous opioid peptide activity is chronically elevated by oral contraceptives, we infused either naloxone or saline into 10 women during the use of, or 5-6 and 9-10 days after stopping, combination birth control pills. A paradoxical increase in prolactin occurred with naloxone infusion during and 5-6 days after stopping the pills. Serum LH levels were not significantly elevated by naloxone until 9-10 days after cessation of pill use. These results suggest that hypothalamic opioid peptide activity is continuously elevated in women taking oral contraceptives.

Adult↗
PubMed1976

Luteinizing hormone secretion in patients presenting with post-oral contraceptive amenorrhoea: evidence for a hypothalamic feedback abnormality.

Twenty-four patients who presented with amenorrhoea after discontinuing oral contraceptives were studied. In fourteen patients underlying conditions were present which could account for the amenorrhoea. Two patients were pregnant, two had premature ovarian failure and four polycystic ovarian disease. Pituitary tumours were present in three patients, and in another three radiological abnormalities of the pituitary fossa suggested the presence of an intrasellar tumour. Basal serum luteinizing hormone levels reliably differentiated ovarian from hypothalamic or pituitary lesions. Varied patterns of serum LH response to clomiphene were present in the patients with post-oral contraceptive amenorrhoea or pituitary lesions. Most patients showed normal hormone response patterns, with a secondary LH peak, but in others a partial response only was seen. In the latter group, who responded normally to exogenous gonadotrophin releasing hormone, no secondary LH peak occurred despite normal oestradiol responses. This suggests an abnormality of the positive feedback system for oestrogens. Subsequent stimulation with clomiphene produced normal LH responses in these patients showing that the abnormality was reversible. These findings are consistent with the hypothesis that post-oral contraceptive amenorrhoea is the result of continuing suppression of normal hypothalamic pituitary feedback systems after the sex steroids have been stopped. The different patterns of hormone response to clomiphene suggest varying degrees of feedback abnormality, and in some patients the positive feedback mechanism only is impaired.

Adolescent↗
PubMed1985

Effect of estrogens on the dexamethasone suppression test in nondepressed women.

It is often suggested that estrogens may cause false-positive dexamethasone suppression test (DST) results. In this study of nine healthy, non-depressed women, DSTs were performed at baseline, immediately following administration of 21 days of oral contraceptives containing either 50 or 80 micrograms of mestranol (a synthetic estrogen) in combination with 1 mg of norethindrone (a synthetic progesterone), and 1 month after discontinuing the oral contraceptives. All subjects had post-dexamethasone cortisol levels less than or equal to 5 micrograms/dl during the study with the exception of two subjects in the mestranol 80 microgram group who had positive DSTs immediately following oral contraceptive administration; one of these subjects continued to have a positive DST 1 month later. DST results should be interpreted with caution if high dose estrogens are taken concurrently or have been recently discontinued.

Adult↗
PubMed1994

Serum profiles of oxytocin during oral contraceptive treatment.

Serum profiles of oxytocin were studied by means of a continuous blood sampling system in five young healthy women before and during treatment with a combined oral contraceptive. Oxytocin levels were determined by a specific radioimmunoassay in blood samples collected in 10-min fractions from 22.00 to 06.00. The values were further analyzed by the pulse detection program PULSAR. Great individual differences in oxytocin profiles were observed, and in some of the women these differences were also pronounced between the two sampling occasions. All 10 profiles demonstrated irregular peaks which occurred with varying frequency. Although the baseline level of oxytocin increased in all women and the average concentration increased in four of the women during treatment, there was no clear-cut effect on the peak frequency. Based on results from animal experiments, it is suggested that the increase in oxytocin levels may be related to an excitatory effect exerted by estrogen on oxytocin secreting neurons.

Adult↗
PubMed1989

[Our experience in using the triphasic contraceptive trisiston for contraception].

The authors carried out studies on 80 women, using Trisistone, a preparation of Germed, Jenapharm, DDR, in the course of 250 cycles, taking into consideration the advantages of triphasic contraceptive preparations as well as the fact that till this moment there were not applied in our country. A good contraceptive efficiency was established. No case with conception was recorded. The side effects were mild and and their frequency varies between 2.4 and 9.7% Irregular bleedings were the only disadvantage of Trisistone, which caused refusal for its usage. It is proposed that Trisistone should be used as an initial contraceptive preparation like the preparations with "mini" doses. In cases with good tolerance women should continue to use it, but they should take another contraceptive preparation, when bleeding occurs.

Contraceptive Agents↗
PubMed2002

[Intrauterine devices in general practice: a prospective study of 300 insertions].

OBJECTIVE: To assess the effectiveness of management practices of copper intrauterine devices (IUD) in general medicine. MATERIAL: and methods. A prospective study was conducted over a four-year period. Thirty-four experimented and volunteer general practitioners inserted 300 IUDs. Two hundred and ninety-seven patients were evaluated. A 375-mg copper IUD was used. Results are presented by 12-month device survival, cumulative discontinuation, and event rates per hundred women. RESULTS: At the end of the study 19.8% (n=59) of the women were lost to follow-up. Exposure time to IUD was 9245 cycles. Mean exposure time was 3917 cycles. Discontinuation rates for IUD were 82%, 67%, and 31% at 12, 36, and 48 months respectively. Renewal rate for this contraceptive device was 31.5%. Results confirmed that IUD were highly effective in this population: Pearl index 0.51% with four pregnancies. A very low expulsion rate (1.68%) and good tolerance (cumulative removal rate for medical reasons at 60 months=6.1%) were observed. At the end of the study, 61.3% of the women included had no complaints and had their IUD removed for desired pregnancy, replacement or personal reasons. CONCLUSIONS: Our findings are similar to reports in the literature; there was no evidence of differences between general practitioners and gynecologists. IUDs inserted by experimented general practitioners are safe and should continue to be offered as a contraceptive option for properly selected women. These findings suggest that specific training on contraceptives should be provided to interested general practitioners

Adult↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1993

Lactational infertility in family planning.

The contraceptive effect of breast-feeding is the single most important determinant of human population growth rates in traditional societies without access to modern forms of contraception; lactational amenorrhoea is Nature's contraceptive. Even today, breast-feeding still prevents more pregnancies than all modern forms of contraception in many developing countries. Afferent neural inputs from the nipple pass via the spinal cord to the hypothalamus, where they cause a local release of beta endorphin. This acts to depress GnRH secretion, thereby inhibiting pituitary gonadotrophin secretion, ovarian follicular development, ovulation and menstruation. The hypothalamic beta endorphin release also inhibits dopamine production, resulting in increased pituitary prolactin secretion. The higher the suckling frequency, the more beta endorphin that is released and hence the longer the duration of lactational amenorrhoea. Lactational amenorrhoea can be relied up to give over 98% contraceptive protection to breast-feeding women in the first 6 months postpartum, regardless of their nutritional status or the time of first supplement introduction to the baby. This is because the first postpartum menstruation usually precedes the first ovulation during these early months. Once menstruation has resumed, lactation's contraceptive effect can no longer be relied upon, even though the woman continues to breast-feed. In breast-feeding women whose amenorrhoea extends beyond 6 months, there is an increasing tendency for the first ovulation to precede the first menstruation, thereby decreasing the reliability of lactational amenorrhoea as a contraceptive. Nevertheless, many women who continue to breast-feed may still have up to 1-2 years of good contraceptive protection from prolonged lactational amenorrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)

Amenorrhea↗
PubMed2002

Male contraception.

Currently approved male-directed contraceptive methods include condoms and vas occlusion. Vas occlusion is very effective but is intended to be non-reversible. Condoms have a relatively high failure rate, at least partially due to compliance problems and are not accepted by many couples. The only other male-oriented methods in clinical trials utilize the administration of testosterone alone or its combination with another gonadotropin-suppressing agent such as a progestin or a gonadotropin-releasing hormone antagonist. Studies published in the 1990s demonstrated that a testosterone-containing hormonal contraceptive method suppressed spermatogenesis to azoospermia in most men and severe oligozoospermia in the remaining. The contraceptive efficacy after treatment with testosterone alone was comparable to that of female hormonal methods. Having proven that reversible male contraception is a reality, present trials are attempting to identify the best androgen delivery system and the most effective androgen plus progestin preparation. It is likely that the first marketed male hormonal contraceptive method will be a long-acting (injectable or implant) combination of an androgen plus a progestin. Research is continuing to identify other target areas for male contraceptive development, including agents with post-testicular and epididymal sites of action.

Androgen Antagonists↗
PubMed2004

Concomitant administration of lumiracoxib and a triphasic oral contraceptive does not affect contraceptive activity or pharmacokinetic profile.

This study evaluated the effect of lumiracoxib on the pharmacokinetics and pharmacodynamics of ethinyl estradiol (EE) and levonorgestrel (LN) in Triphasil-28 (a triphasic oral contraceptive). Females stabilized on Triphasil-28 continued on Triphasil-28 alone for another month (Treatment Period 1), then also received lumiracoxib (400 mg daily) or placebo for 28 days each (Periods 2 and 3) in a double-blind crossover design. Plasma pharmacokinetic profiles were assessed on Day 21 of Periods 2 and 3. Progesterone and plasma sex hormone binding globulin (SHBG) concentrations were measured before and 2 hours after Triphasil-28 administration on Day 21 of all three treatment periods. Lumiracoxib had no significant effect on EE or LN pharmacokinetics or on progesterone or SHBG concentrations, indicating that anovulation and Triphasil-28 effectiveness was maintained. Adverse events were similar for lumiracoxib and placebo. Therefore, no clinically important consequences are anticipated if lumiracoxib is coadministered with oral contraceptives containing EE or LN.

Adolescent↗
PubMed1982

Ethnic variation in adolescent use of a contraceptive service.

This paper compares black, Hispanic, and white teenagers' experiences with a contraception service in New York City. Data were obtained from 3858 patients who made nearly 12,000 visits to the program during its first 3 years of operation. Patients' reasons for using the contraception facility, their visit patterns, clinic continuation rates, methods accepted, patterns of method utilization, as well as their pregnancy rates and intentions for pregnancy resolution are examined. Black patients had more clinic visits than white and Hispanic patients, and their duration of program contact was the longest. Several method preference differences existed among the three ethnic groups. Pregnancy rates while the patients were in contact with the program were highest among blacks, followed by Hispanics and then whites. Service delivery directions suggested by these findings are discussed.

Adolescent↗
PubMed1992

The androgenicity of oral contraceptives: the young patient's concerns.

Sexual activity is quite common among women aged 14 to 20 in developed countries, averaging perhaps 10% at age 15 to about 70% at 19. Thus, the need for contraception may begin quite early in life and will continue for as long as 30 years. One of the best candidates for long-term contraception for young sexually active females is the oral contraceptive (OC), which provides health benefits besides contraception. Long-term benefits include lowered rates of ovarian and endometrial cancer, as well as of benign breast disease and ovarian cysts. Another benefit is protection against upper-tract sequelae of sexually transmitted diseases. Short-term benefits are correction of menstrual irregularity, reduction in menstrual flow, and diminished premenstrual syndrome and dysmenorrhea. Recent OC formulations contain only one-third the estrogenic potency of older OCs and therefore are associated with dramatic decreases in what were always the major side effects of OCs: heart attack, stroke, and pulmonary embolism. Other side effects of OCs have been most closely associated with the progestogenic component, and are related to the androgenic effects of progestins, particularly some synthetic progestins. However, some new synthetic progestins have been found to have minimal androgen receptor activity in preclinical testing and to cause minimal or no androgen-related side effects in clinical trials. One of these new progestins having a favorable androgenic profile is norgestimate. Its efficacy and safety in combination with low doses of ethinyl estradiol have been documented in the European and the American literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗
PubMed1991

The effect of ciprofloxacin on oral contraceptive steroid treatments.

The effect of ciprofloxacin, a new broad-spectrum quinolone derivative, on concomitant oral contraceptive steroids has been studied in a double-blind cross-over placebo-controlled randomized trial. Ten healthy women using long-term oral contraceptive steroids received either ciprofloxacin 500 mg BID or placebo during two consecutive cycles. Therapy was continued for seven days from the first day of contraceptive treatment. FSH, LH and oestradiol blood levels were repeatedly determined to monitor contraceptive steroid efficacy. A seven-day treatment with ciprofloxacin did not affect steroid treatment outcome and appears to be safe in women using this contraceptive method.

Adult↗
PubMed2003

[MR-imaging of the breast at 0.5 Tesla: menstrual-cycle dependency of parenchymal contrast enhancement in healthy volunteers with oral contraceptive use?].

INTRODUCTION: To evaluate changes of contrast medium enhancement of the breast parenchyma due to menstrual cycle in healthy volunteers with oral contraceptive use in MR-imaging of the breast. MATERIAL AND METHODS: 15 healthy volunteers (age: 22 - 36, mean 28,2) without breast disease were examined two times during one menstrual cycle (days 7 - 14 and days 21 - 2). Two volunteers were examined only in the second part of the cycle (days 21 - 2). All volunteers used oral contraceptives for more than 6 month continuously. Examinations were performed with a 0,5 T magnet (dynamic 3D-gradient echo protocol with subtraction postprocessing). We evaluated the number of enhancing foci and the parenchymal contrast medium enhancement during the different phases of the cycle by region of interest. RESULTS: Only a total of two enhancing foci were found in 2 of 17 volunteers. Time/signal intensity diagrams in these both cases were not suspicious (< 80 % initial signal increase after of contrast medium injection, no wash-out phenomenon) and sonography of the breast in these two cases was inconspicuous. Contrast medium enhancement of breast parenchyma in cycle days 7 - 14 (mean enhancement: 0.12 - 0.26, minutes 1 - 9 p. i.) was not significantly different (p = 0.2209; Wilcoxon signed rank test) from cycle days 21 - 2 (mean: 0.13 - 0.32). CONCLUSION: Menstrual cycle dependency of parenchymal contrast medium enhancement seems to be of minor relevance for premenopausal women with use of oral contraceptives.

Adult↗
PubMed1997

Introductory study of the once-a-month, injectable contraceptive Cyclofem in Brazil, Chile, Colombia, and Peru.

An introductory trial with the injectable contraceptive Cyclofem was carried out in Brazil, Chile, Colombia, and Peru, with participation by 3,183 women. Women were followed-up for up to 2 years of use and the data were evaluated by life table analysis. A total of 29,676 women-months were accumulated for up to 2 years. No pregnancies were observed in the 2 years. The discontinuation rates for amenorrhea in the first year ranged from 3.4 in Brazil to 8.1 in Colombia, and for menstrual disturbances from 5.1 in Chile to 9.2 in Brazil. The discontinuation rates for other medical reasons ranged from 7.8 in Brazil to 26.3 in Colombia, and for personal reasons from 17.2 in Chile to 23.5 in Brazil. Continuation rates ranged from 42.3 in Colombia to 52 in Chile. In the second year of observation the rates of discontinuation were lower than those observed in the first year, with the exception of personal reasons in Brazil, which were the same as those observed in the first year. Continuation rates ranged from 19.4 in Brazil to 36.8 in Chile. The comparison of reasons for discontinuation in selected clinics showed that the rate for amenorrhea in one clinic in Chile was more than three times that in others and in Peru was seven times more in one clinic than in another. Regarding menstrual disturbances, in Peru one clinic presented a rate three times higher than the others. The main reasons for discontinuation due to other medical reasons were headache and weight gain. In conclusion, Cyclofem presented a high contraceptive efficacy and an acceptable rate of continuation and discontinuation for up to 2 years in the four countries.

Adult↗
PubMedDate not supplied

A clinician's response to the oral contraceptive thrombosis controversy.

The controversy involving new progestin oral contraceptives (OC) began in late 1995, continued through 1996, and started to reach resolution in 1997. The fundamental question is whether OC containing desogestrel and gestodene have a different risk of thrombosis compared with OC containing older progestins. Correcting for preferential prescribing and the healthy user effect leads to the conclusion that all low-dose OC--regardless of progestin type--have an increased risk of venous thromboembolism. Low-dose OC do not increase the risk of myocardial infarction or stroke in healthy, non-smoking women less than 35 years of age. With effective patient screening for risk factors, the serious side effects of OC can be virtually eliminated.

Contraceptives, Oral, Combined↗