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Contraception in the latter part of reproductive life.

Contraception in the latter part of reproductive life is particularly important because of the increased fetal and maternal mortality associated with pregnancy in this age group. The combined pill can be continued until the menopause in healthy, non-smoking women with no additional risk. The advantages of the combined pill include protection against menopausal symptoms as well as some of the common gynecological disorders. Progestogen-only formulations can now be administered by both oral and non-oral routes. The levonorgestrel-releasing IUD is an exciting new development, especially suited to this age group because of the reduction in menstrual loss. Although barrier methods often prove unacceptable if used for the first time in the late thirties and forties, they have no serious adverse effects and in addition provide protection against cervical intraepithelial neoplasia and sexually transmitted disease.

Adult↗

Differences between emergency contraception users in the United States and the United Kingdom.

OBJECTIVES: to characterize emergency contraception (EC) users and clinical trial participants in the United States and the United Kingdom, comparing previous EC use and awareness, contraceptive history, and experience with EC. METHODS: We collected data from all EC seekers (n=5383) at 1 US and 2 UK clinics (9/97-8/98). We also collected detailed information from women (n=2157) enrolling in an EC trial at the first 3 clinics and 2 additional UK sites (9/97-2/00). RESULTS: More US (16%) than UK (4%) women reported additional acts (other than in the last 5 days) of unprotected sex during the cycle in which they sought EC. Fifty-eight percent of UK trial participants had used EC previously compared to 18% in the United States. Most participants in both groups used contraception regularly and reported needing EC because of condom breaks (67% and 56%). More UK than US participants used an ongoing method of contraception (38% v 28%). US women reported more side effects at follow-up than UK women did (76% v 59%), although similar proportions would take EC again or recommend it. CONCLUSIONS: US and UK women in our trial experienced different side effects. Researchers should use caution when presenting aggregate results from international multicenter trials. In addition, readers should be aware that such aggregate results might mask important geographical differences. More research on experience with EC and barriers to contraceptive use in the United States is needed.

Adolescent↗