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PubMed2000

Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women.

OBJECTIVES: We explored perceptions of the safety and side effects of oral and injectable hormonal contraceptives among low-income women at high risk of unintended pregnancy. METHODS: Overall safety perceptions, specific health concerns, and the relationship between these safety perceptions and contraceptive choices were determined by focus groups and questionnaires obtained from white non-Latina (n = 19), English-speaking (n = 21), and Spanish-speaking Latina women (n = 19). RESULTS: Uncertainty or ambivalence about the safety of oral and injectable contraceptives was reported by 41% and 70% of respondents respectively, while 20% considered these methods to be mostly harmful. Personal experiences and stories from social networks proved to be more salient than medical opinions in shaping safety perceptions. Side effects and concerns about long-term health effects were common themes. While white non-Latina women focused predominantly on physical side effects, emotional side effects also contributed to Latinas' decisions about contraceptive switching. Spanish-speaking Latinas differed from English-speaking Latinas in other attitudinal dimensions, contraceptive use prevalence, and access to contraceptive services. CONCLUSION: Low-income mothers lacked confidence in method safety and had many concerns about the side effects of oral and injectable contraceptives. Because such concerns can be a barrier to contraceptive use, these perceptions need to be corrected to encourage more effective use of hormonal methods and to prevent unintended pregnancies. Culturally appropriate interventions should focus on client-provider interactions, social networks, and access to care.

Adult↗
PubMed2003

Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

OBJECTIVE: This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars. PATIENTS AND METHOD: Two hundred and sixty seven women, aged 17 - 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis). RESULTS: Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017). CONCLUSIONS: The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.

Adolescent↗
PubMed2001

The use of emergency contraception in Australasian emergency departments.

OBJECTIVE: To review the prescribing of emergency contraception by emergency departments in Australasia and compare it with other providers. METHODS: A postal questionnaire was sent to the director of each of the 79 Australasian College for Emergency Medicine accredited emergency departments in Australasia inquiring about the availability and prescribing habits for emergency contraception within each department. RESULTS: Of the 79 emergency departments, 69 (87.3%) responded to the questionnaire and were aware of the 'emergency contraception regimen'. The majority of departments prescribed appropriately (56%) and only one department did not arrange adequate follow up. Anti-emetics are always used by 45 departments (78.9%). Discussion of future contraceptive needs at the time of presentation was only undertaken by 25 departments (43.9%). Written clinical guidelines for emergency contraception were present in 28 departments (40.6%). CONCLUSIONS: Emergency departments are accessed by patients requesting contraception following unprotected intercourse or contraceptive failure. The prescribing of emergency contraception in Australasian emergency departments is comparable with other providers but substantial improvements could be made. Suggestions to assist this improvement include written clinical guidelines and patient information and purpose-made medication packs.

Antiemetics↗
PubMed2003

Emergency contraception: knowledge, attitude, and practices among health care providers in North India.

AIMS: The present study was conducted to assess knowledge, attitude, and practice of emergency contraception in health care providers and users in North India. METHODS: A survey was carried out with the help of a predesigned questionnaire comprising of two groups of clients (abortion seekers at Family Welfare center, and non-medical college students (prospective clients)); and 4 groups of health care providers (gynecologists, general practitioners, paramedical workers, and medical students). RESULTS: Practically none of the clients were familiar with the concept of emergency contraception and so the rest of the information could not be obtained from them and hence this was excluded from further analysis. Many providers (84.8% gynecologists, 41.0% general practitioners, 2.7% paramedical workers, and 64.4% medical students) were vaguely familiar with the concept of emergency contraception, very few knew accurately about timing and doses. The majority of these thought it to be an essential component of contraceptive services but preferred distribution through health care providers only. The practice of emergency contraception as reported in the present survey was inconsistent. Yuzpe regimen was the most commonly used method and nausea/vomiting were the commonest side-effects. The question of efficacy of emergency contraception was not answered reliably by the health care providers. CONCLUSIONS: Awareness about emergency contraception among the general population and paramedical workers studied is practically nonexistent. Precise knowledge about emergency contraception among doctors (both gynecologists and general practitioners) is also inadequate. Prescription practices can improve by generating demand and training of health care providers.

Allied Health Personnel↗
PubMed2000

Ziprasidone and the pharmacokinetics of a combined oral contraceptive.

AIMS: To determine whether multiple doses of ziprasidone alter the steady-state pharmacokinetics of the component steroids, ethinyloestradiol and levonorgestrel, of an oral contraceptive; to evaluate the tolerability of a co-administered combined oral contraceptive and ziprasidone; and to compare plasma concentrations of prolactin in subjects taking a combined oral contraceptive with placebo or ziprasidone. METHODS: Nineteen women taking a combined oral contraceptive (ethinyloestradiol 30 microg day(-1) and levonorgestrel 150 microg day(-1)) were enrolled into a double-blind, placebo-controlled, two-way crossover study. They received ziprasidone 40 mg day- 1 in two divided daily doses or placebo for 8 days (days 8-15) in one of two 21 day treatment periods separated by a 7 day washout period. Venous blood samples were collected immediately before and up to 24 h after the morning dose of oral contraceptive and ziprasidone or placebo on day 15 of each 21 day treatment period. These were assayed for ethinyloestradiol and levonorgestrel and the resulting data used to derive pharmacokinetic data for these steroids. Additional samples were collected immediately before and 4 h after the morning dose of oral contraceptive and ziprasidone or placebo on day 15 of each 21 day treatment period for prolactin assay. All observed and volunteered adverse events were recorded throughout the study. RESULTS: The mean AUC(0,24 h), Cmax and tmax for ethinyloestradiol and the mean AUC(0, 24 h) and Cmax for levonorgestrel during ziprasidone co-administration were not statistically significantly different from corresponding values occurring during placebo co-administration. The tmax for levonorgestrel was approximately 0.5 h longer. Concomitant therapy with a combined oral contraceptive and ziprasidone did not result in adverse events not previously seen with either preparation alone. CONCLUSIONS: The findings of this study suggest that, based on pharmacokinetic and tolerability data, ziprasidone may be co-administered with ethinyloestradiol and levonorgestrel without loss of contraceptive efficacy or increased risk of adverse events.

Adolescent↗
PubMed2002

Contraception of women with intellectual disability: prevalence and determinants.

The contraception of women with intellectual disability (ID) is a major concern for caregivers. However, the prevalence of contraception and the frequency of use of different methods (e.g. sterilization) remain generally unknown. Moreover, indications specific to women with ID are controversial. The present authors conducted a population-based study among 97% of the women with ID aged between 18 and 46 years attending government-funded facilities in Brussels and the nearby province of Walloon Brabant in Belgium. Out of 397 subjects, 40.8% did not use any contraceptive method, 22.2% were sterilized, 18.4% used an oral contraceptive agent, 17.6% used depotmedroxyprogesterone acetate and 1% used an intrauterine device. These figures differ widely from those of the general Belgian population. Binary logistic regression for 'contraceptive utilization' showed the strong influence of institutional factors such as sleeping environment (i.e. institutional or parental), sexual relationship policy and contraception policy. Having or having had a boyfriend is also correlated with a stronger probability of contraceptive use. Other factors have a smaller influence (e.g. a milder level of ID). Very few factors, none of which are medical, are correlated with an increased use of a specific method. The present results are discussed in the light of the general medical application of contraception and the commonly assumed specific indications for women with ID.

Adult↗
PubMed2000

Contraception: a new practical learning package.

BACKGROUND: A new self-directed learning package was developed to assist medical students learn the counselling and practical skills to enable them to communicate with men and women about contraception and related matters. OBJECTIVES: This paper describes the package and the way it was facilitated, the students' ratings of the package and their feedback about the session on the first time it was presented at four teaching hospitals. RESULTS: The students rated the contraception package as average. The reasons given were: no introduction to the contraception session, lack of a trained person to conduct and facilitate the contraception learning session, poor organization at one of the hospitals and too little emphasis on self-assessment. The assumption that the students had a basic hormonal knowledge prior to the contraception sessions was incorrect. DISCUSSION: The results suggest the contraception learning package needs a person with contraceptive knowledge, patient-doctor skills and experience with self-directed learning to be present throughout the 3-hour session and for tools to be available that emphasize self-assessment during the session. OUTCOME: The modifications to be made to the learning package include pairing male and female students, a reduction in duration of the learning stations, an additional learning station relating to hormonal contraception, and inclusion of pregnancy and ovulation testing. These modifications were suggested by the participating students.

Adult↗
PubMed1999

Benefits and risks of third-generation oral contraceptives.

OBJECTIVE: To evaluate the risks and benefits of third-generation oral contraceptives. DATA SOURCES: A MEDLINE search was done for English language articles published from 1985 through 1998 relating to the side-effect profile of third-generation oral contraceptives or their association with cardiovascular or thromboembolic disease. All articles containing original data were included. DATA SYNTHESIS: The risk of venous thromboembolism appears to be 1.5- to 2.7-fold greater in users of third-generation, compared with second-generation, oral contraceptives. Compared with nonusers, women who use third-generation oral contraceptives may have a 4.8- to 9.4-fold greater risk of venous thromboembolism. Users of third-generation oral contraceptives do not appear to have an increased risk of myocardial infarction compared with nonusers and may have risk of myocardial infarction of 0.26 to 0.7 compared with second-generation users. Whether third-generation oral contraceptives are associated with a decreased stroke risk is still not clear. CONCLUSIONS: Although third-generation oral contraceptives most likely increase a user's risk of venous thromboembolism, their improved side-effect profile and their possible decreased association with myocardial infarction and stroke may make them a useful new class of oral contraceptives for most women except those at increased risk of venous thrombosis.

Contraceptives, Oral↗
PubMed2003

The RATIO study: oral contraceptives and the risk of peripheral arterial disease in young women.

With regard to oral contraceptives, much research has concentrated on venous thrombosis and on the coronary and cerebral forms of atherosclerotic disease, while peripheral arterial disease (PAD) has received little attention. In this case-control study, we assessed oral contraceptive use and the risk of PAD in young women using a population-based case-control study. The women were 18-49 years of age, and had been admitted to a collaborating hospital between January 1990 and October 1995, and had a diagnosis of PAD. Participants were patients with PAD (n = 152), and control women (n = 925), identified by random digit dialing. The diagnosis of PAD was based almost exclusively on intra-arterial angiography. Patients and control subjects filled out the same structured questionnaire, which included questions on medical history, cardiovascular risk factors, and contraceptive use. The adjusted odds ratio for PAD in women using any type of oral contraceptives vs. no use, was 3.8 (95% CI 2.4-5.8). When first generation oral contraceptive use was compared with no use, the odds ratio was 8.7 (95% CI 3.6-21.3). For second and third generation oral contraceptives, the adjusted odds ratios (compared with non-users) were 2.6 (95% CI 1.4-4.9) and 3.0 (95% CI 1.4-6.6), respectively. This is the first study on oral contraceptive use and PAD in humans. All types of oral contraceptives were associated with an increased risk of PAD.

Adult↗
PubMed2002

Venous thromboembolism in young women; role of thrombophilic mutations and oral contraceptive use.

AIMS: The interaction between the R506Q mutation of factor V and the G20210A mutation of prothrombin with oral contraceptives on venous thromboembolism was evaluated. METHODS AND RESULTS: Three hundred and one women of reproductive age who had venous thromboembolism (140 while using oral contraceptives) and 650 healthy women (173 on oral contraceptives at presentation) were examined. Of the patients, 19.3% were carriers of R506Q (two homozygotes) and 9.6% were heterozygous carriers of G20210A; eight patients (2.7%) were heterozygous for both mutations. Among controls, 2.9% were carriers of R506Q, 3.1% of G20210A, while one case was a heterozygous carrier of both mutations. The relative risk (odds ratio) associated with carriership of R506Q or G20210A mutations was 10.3 and 4.7, respectively; it was 45.6 in carriers of both mutations. The odds ratio of using oral contraceptives in the absence of both mutations was 2.4. The odds ratios according to oral contraceptives use and the presence of R506Q or G20210A or both mutations were 41.0, 58.6 and 86.5, respectively. While the odds ratio for R506Q remains elevated (8.9) in non-oral contraceptive users, the odds ratio for G20210A was 2.0 and did not reach statistical significance. CONCLUSIONS: Our data showed a strong interaction between oral contraceptive use and the presence of either R506Q or G20210A mutations. In non-oral contraceptive users the risk of venous thromboembolism was significantly increased in carriers of R506Q but not in those with the G20210A mutation.

Adolescent↗
PubMed2005

Combined oral contraceptives in women with systemic lupus erythematosus.

BACKGROUND: Oral contraceptives are rarely prescribed for women with systemic lupus erythematosus, because of concern about potential negative side effects. In this double-blind, randomized, noninferiority trial, we prospectively evaluated the effect of oral contraceptives on lupus activity in premenopausal women with systemic lupus erythematosus. METHODS: A total of 183 women with inactive (76 percent) or stable active (24 percent) systemic lupus erythematosus at 15 U.S. sites were randomly assigned to receive either oral contraceptives (triphasic ethinyl estradiol at a dose of 35 microg plus norethindrone at a dose of 0.5 to 1 mg for 12 cycles of 28 days each; 91 women) or placebo (92 women) and were evaluated at months 1, 2, 3, 6, 9, and 12. Subjects were excluded if they had moderate or high levels of anticardiolipin antibodies, lupus anticoagulant, or a history of thrombosis. RESULTS: The primary end point, a severe lupus flare, occurred in 7 of 91 subjects receiving oral contraceptives (7.7 percent) as compared with 7 of 92 subjects receiving placebo (7.6 percent). The 12-month rates of severe flare were similar: 0.084 for the group receiving oral contraceptives and 0.087 for the placebo group (P=0.95; upper limit of the one-sided 95 percent confidence interval for this difference, 0.069, which is within the prespecified 9 percent margin for noninferiority). Rates of mild or moderate flares were 1.40 flares per person-year for subjects receiving oral contraceptives and 1.44 flares per person-year for subjects receiving placebo (relative risk, 0.98; P=0.86). In the group that was randomized to receive oral contraceptives, there was one deep venous thrombosis and one clotted graft; in the placebo group, there was one deep venous thrombosis, one ocular thrombosis, one superficial thrombophlebitis, and one death (after cessation of the trial). CONCLUSIONS: Our study indicates that oral contraceptives do not increase the risk of flare among women with systemic lupus erythematosus whose disease is stable.

Adolescent↗
PubMed2001

Oral contraceptive use in perimenopause.

Perimenopause represents a transition period lasting about 5 years before the permanent cessation of spontaneous menses. During this transition, the emphasis of clinical care changes. Although women still need effective contraception during perimenopause, issues including loss of bone mineral density, menstrual cycle changes, and vasomotor instability also need to be addressed. Hormone replacement therapy is not the first-line treatment for women with symptomatic perimenopause because hormone replacement therapy neither suppresses ovulation nor provides contraception; also, it will not prevent and in fact may aggravate unpredictable perimenopausal bleeding. Oral contraceptives offer many benefits for healthy, nonsmoking, perimenopausal women. Oral contraceptive use by women in their 40s has been found to decrease the risk of postmenopausal hip fractures and regularize menses in women with dysfunctional uterine bleeding, reducing the need for surgical intervention for benign menstrual conditions. Use of oral contraceptives also can reduce long-term risk of endometrial and ovarian cancers. There is also good evidence that oral contraceptives relieve vasomotor symptoms in perimenopausal women. Oral contraceptives can be viewed as a strategy not only to improve perimenopausal symptoms, provide effective contraception, and reduce some long-term health risks, but also to enhance the quality of life for perimenopausal women.

Contraceptives, Oral↗
PubMed2001

Current perspectives on oral contraceptive use.

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life.

Contraceptives, Oral↗
PubMed2002

Family history of cancer, oral contraceptive use, and ovarian cancer risk.

OBJECTIVE: The purpose of this study was to determine whether women with a family history of ovarian cancer are at reduced risk of ovarian cancer from the use of oral contraceptives and to compare their risk with that of women with no family history of ovarian cancer. STUDY DESIGN: A population-based case-controlled study was conducted from May 1994 through July 1998 in which 767 women aged 20 to 69 years with a diagnosis of epithelial ovarian cancer were ascertained from 39 hospitals in 3 northeastern states. Personal interviews with the women and 1367 control subjects provided data that allowed us to estimate the relative risk of ovarian cancer in relation to a family history of cancer and total duration of oral contraception. RESULTS: Among the 33 case patients and 24 control subjects with a first-degree family history of ovarian cancer, risk of ovarian cancer declined with increasing duration of oral contraception (P =.01). Risk reduction from short-term use of oral contraceptives (< or = 48 months) did not differ significantly by family history (combined estimate of odds ratio, 0.72; 90% CI, 0.59%-0.87%). Risk reduction from long-term use of oral contraceptives (>48 months) was greater in women with a positive family history of ovarian cancer (odds ratio, 0.12) than in women with a negative family history of ovarian cancer (odds ratio, 0.51; test of interaction, P =.04; 692 case patients, 1279 control subjects). CONCLUSION: Four to 8 years of oral contraception may substantially reduce the risk of ovarian cancer by age 70 years in women with a family history of the disease, from approximately 4 women per 100 women who did not use oral contraceptives to only 2 women per 100 women who did use oral contraceptives.

Adult↗
PubMed2004

Acoustic measures of vocal stability during different speech tasks in young women using oral contraceptives: a retrospective study.

OBJECTIVES: To compare objective voice measures of vocal stability during different speech tasks in women taking oral contraceptives to those in women not taking oral contraceptives. METHODS: Voice recordings obtained from 28 women, aged 20-30 years old, were used for the study. Eighteen of the women were taking some form of oral contraception at the time of the recording (OC women); ten women were not taking any oral contraceptive medication (NOC women). Measures related to pitch, vocal stability, and loudness were obtained from sustained vowel and paragraph reading tasks. RESULTS: The OC women demonstrated significantly higher pitch levels but lower values related to measures of vocal stability. CONCLUSIONS: The use of oral contraceptives appears to exert a positive influence upon vocal fold function. Women taking oral contraceptives demonstrate higher pitch levels and greater stability during phonation than do women not taking oral contraceptives. This improvement in vocal function is contributed to the more stable hormonal environment that occurs with the use of oral contraceptives.

Adult↗
PubMed1996

Specific and total carotenoid intakes among oral contraceptive and estrogen hormone users in the United States.

OBJECTIVE: To compare carotenoid intakes between hormone users and nonusers in a nationally representative sample of US women by demographic and lifestyle characteristics and to identify those with potentially greater risk for disease. DESIGN: Data from the 1987 National Health Interview Survey's-Epidemiology Supplement food frequency questionnaire were linked to the USDA-NCI Carotenoid database to estimate mean total and specific carotenoid intakes. SUBJECTS: Women (n = 8,962) were grouped by menopausal status and classified by hormone use into premenopausal oral contraceptive users/nonusers (n = 5,918) and postmenopausal estrogen replacement hormone users/nonusers (n = 3,044). STATISTICAL ANALYSES PERFORMED: Mean carotenoid intakes and standard errors were weighted using SUDAAN and adjusted for potential confounding factors using multiple linear regression analysis. Statistically significant differences were at p values < 0.01. RESULTS: Compared to nonusers, oral contraceptive users had lower specific carotenoid intakes. Demographic and lifestyle characteristics differed between oral contraceptive users/nonusers and were examined in relation to carotenoid intakes. More oral contraceptive users than nonusers were married, highly educated, drank alcoholic beverages, and smoked. After adjustment for these factors in a multiple linear regression model, the associations between oral contraceptive use and carotenoid intake remained statistically significant. Mean carotenoid intakes were not significantly different among estrogen hormone replacement users versus nonusers. CONCLUSIONS: Oral contraceptive users have lower dietary carotenoid intakes than nonusers. Since oral contraceptive users smoke and drink more than nonusers, and both factors are associated with lower carotenoid intakes, oral contraceptive users form a potential high risk group for disease.

Alcohol Drinking↗
PubMed2005

Knowledge, attitudes and practices regarding emergency contraception among family-planning providers in Turkey.

OBJECTIVE: The research was planned descriptively to define the knowledge, attitudes and practices of family-planning providers regarding emergency contraception. METHODS: The sample included 21 Maternal-Child Health/Family Planning Centers located in the European region of Istanbul, and the research was conducted with 41 family-planning providers employed in these facilities. RESULTS: All of the family-planning providers were aware of emergency contraception, 82.9% accurately defined emergency contraception, 61% stated that emergency contraception was legal, and 53.7% expressed that it could be employed in rape indications. All the family-planning providers (100%) cited combined oral contraceptives, 73.2% cited intrauterine devices, and 9.8% cited other methods (mifepristone, high-dose estrogen, menstrual regulation). Seventy-eight per cent of the family-planning providers stated that they had applied emergency contraception previously, while 53.7% gave limited support to emergency contraception. Two sample cases were given to family-planning providers to define their attitudes, to the first of which most of them were positive. All of them were positive towards the second sample. CONCLUSION: Family-planning providers, whose duty is to support women in critical family-planning and reproductive decisions using their experiences and skills, are supposed to have broad knowledge on the matter of emergency contraception.

Adult↗
PubMed2004

Knowledge and attitudes towards emergency contraception of health-care providers in a region with a high birth rate.

OBJECTIVE: To assess the knowledge of, attitude towards and practices of emergency contraception among health-care providers at a university hospital located in a region with a high birth rate. METHODS: The survey was conducted among 214 health-care providers working at a university hospital located in eastern Turkey. RESULTS: Two hundred participants completed the questionnaire. Of the respondents, 26.0% said that they did not know anything about emergency contraception, while the remaining 74.0% said that they knew about at least one of the methods of emergency contraception. But among these, the knowledge of 38.5% of the participants about emergency contraception was accurate and that of 61.5% was inaccurate. Thirty-four percent of the respondents stated that they had previously required personally to use emergency contraceptive methods. The most commonly used emergency contraceptive methods were oral contraceptives (69.1%) and intrauterine device (14.7%). None of the respondents knew anything about mifepristone and levonorgestrel. CONCLUSION: There is a knowledge deficit among health-care providers who play a significant role in the dissemination of the information about emergency contraception.

Adult↗