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PubMed2001

The levonorgestrel intrauterine system: the benefits of reduced bleeding.

The levonorgestrel intrauterine system (LNG-IUS) offers a new therapeutic concept that combines a highly efficient contraceptive with a treatment that reduces menstrual blood loss in both normal women and those with menorrhagia. Initially developed to decrease the risk of expulsion of the intrauterine contraceptive device by reducing myometrial contractility, recent clinical studies have shown that the LNG-IUS provides excellent contraception without many of the adverse effects associated with the conventional intrauterine contraceptive device. The main mechanism of action of the LNG-IUS appears to be at the level of the endometrium, where the high dose of local progestogen causes decidualization, epithelial atrophy and direct vascular changes. Whilst some women experience systemic hormonal effects, circulating concentrations of levonorgestrel are low in comparison to those seen after the levonorgestrel progestogen-only pill. The LNG-IUS results in a dramatic reduction in menstrual blood loss. In turn, this has led researchers to investigate the LNG-IUS as an alternative to surgery for the treatment of dysfunctional uterine bleeding, uterine fibroids and adenomyosis. The system has also been used as a means of delivering progestogen for endometrial protection in postmenopausal hormone replacement regimens. The main side-effect of the LNG-IUS is irregular breakthrough bleeding. This is most common in the first 6 months after insertion. Detailed counselling is crucial to explain this anticipated effect, in order to reduce unnecessary discontinuation of treatment. After 6 months' treatment with the LNG-IUS, 20% of women become amenorrheic, rising to 50% after 5 years. Again, it is important to explain that this is an expected phenomenon, that it is not related to disorders of the hypothalamic-pituitary-ovarian axis, and that this 'bleed-free' status might indeed be viewed as a positive feature in its own right.

Administration, Intravaginal↗
PubMed1984

Relationship between contraceptive method and vaginal flora.

This study was undertaken to assess whether the vaginal flora was affected by the method of contraception, and in particular as to whether the incidence of vaginal candidiasis increased when oral contraceptives were used. One thousand and two consecutive vaginal or cervical swabs from women attending a family planning centre were cultured. Candida albicans was isolated from 13% of women using no contraception, 16% using oral contraceptives, and from 9%, 19% and 18% of those using diaphragms, intrauterine contraceptive devices (IUCD) and condoms respectively. These differences were not statistically significant. Women using an IUCD had significantly more Gram-positive cocci cultured than women in any other group, while those using diaphragms had significantly more Gram-negative bacilli. Our clinical impression that the use of oral contraceptives led to an increase in vaginal candidiasis, was not confirmed by this study.

Candidiasis, Vulvovaginal↗
PubMed1978

Vitamin B6 status of Nigerian women using various methods of contraception.

The vitamin B6 status of Nigerian women, and the effects of three contraceptive methods--intrauterine contraceptive device, injectable progestogen, and combination estrogen-progestogen oral contraceptive pills--on the vitamin B6 status of these women were assessed by measuring the erythrocyte alanine aminotransferase (Ala-AT) activity both with and without in vitro stimulation by pyridoxal-5'-phosphate. The unstimulated Ala-AT activity and the Ala-AT index (ratio of pyridoxal-5'-phosphate-stimulated:unstimulated activity) were used as indications of vitamin B6 status. The criterion for vitamin B6 deficiency was an Ala-AT index greater than 1.25. Of the 238 women in the total sample, 11% were judged to be deficient. There were no significant differences in the mean Ala-AT activity, mean Ala-AT index or rate of deficiency foun in the control and three contraceptive groups. The absence of an effect of oral contraceptives on vitamin B6 status is in contrast with other cross-sectional studies, but in agreement with controlled longitudinal studies. The packed cell volume and reticulocyte count were also measured and were significantly affected by contraceptive steroids, but these effects are not thought to be of clinical importance.

Adult↗
PubMed1993

Emergency contraception.

The term 'emergency contraception', as employed in this paper, refers to methods that are used as emergency procedures to prevent pregnancy following unprotected intercourse. Alternative, less appropriate, terms are postcoital and 'morning-after' contraception. References to postcoital preparations can be found as far back as 1500 BC in Egyptian papyri, but it was not until fairly recently that contraceptive research has been able to at least partially fulfill that need. The development of hormonal methods of emergency contraception goes back to the 1960s when the first human trials of postcoitally administered high-dose oestrogens were undertaken. Combined oestrogen- progestogen combination therapy (the so-called Yuzpe regimen) was introduced in the early 1970s, while the postcoital insertion of an intrauterine contraceptive device (IUD) for emergency contraception was first reported in 1976. Other compounds that have been tested more recently include levonorgestrel, the antiprogestogen mifepristone, and danazol. Although there is some debate about the magnitude of the protective effect, few people question the important role that emergency contraception can play in preventing unwanted pregnancy and hence maternal mortality and morbidity resulting from unsafe abortion. Given that the most often used methods of emergency contraception, namely the Yuzpe regimen and postcoital insertion of an IUD, rely on technology that has been available for some 30 years, family planning programmes that claim to be concerned with improving women's reproductive health, cannot really be excused if they do not provide emergency contraception as part of their routine services.

Contraception↗
PubMed1984

Actinomyces odontolyticus isolated from the female genital tract.

Actinomyces odontolyticus was isolated from genital tract specimens from 4.8% of 561 women fitted with intrauterine contraceptive devices and from 4% of 101 women with pelvic inflammatory disease and 1.8% of 525 women without pelvic inflammatory disease who were not known to be intrauterine contraceptive device wearers. The strains were isolated by prolonged anaerobic incubation of blood agar, with or without added 5% metronidazole or 1% neomycin. A odontolyticus has not been previously reported in cervico-vaginal specimens, and possible reasons for this are discussed.

Actinomyces↗
PubMed1996

The use of nomegestrol acetate subdermal contraceptive implant, uniplant, during lactation.

Uniplant is a single contraceptive implant intended for one year use. It contains the progestogen nomegestrol acetate. The clinical performance and the effect of its use during the first postpartum year on breastfeeding performance and growth and health of the infants were studied and compared to the findings in a parallel group who used an intrauterine contraceptive device (IUD) in a prospective, non-randomized study. This was carried out in Assiut, Egypt. Two-hundred-forty fully breastfeeding mothers asking for initiation of contraception early postpartum were assigned according to their choices into either nomegestrol subdermal contraceptive implant (Uniplant) (120 women) or intrauterine contraceptive device (CuT 380A) (120 women). The mother and infant pairs were followed up at monthly intervals during the first three months and at two-month intervals thereafter up until the first birthday of the baby. No pregnancy occurred in the two groups. Amenorrhea was significantly more prolonged in the Uniplant group than in the IUD group. There were no significant differences in net continuation rates between the two groups (88.3 versus 92.4 per 100 women, respectively). There were no significant differences between the two groups in the number of breastfeeding episodes, time of weaning, and the cumulative rates of full and partial breastfeeding. There were no significant differences between the two groups in infant weight, weight gain per day, or in infant linear growth. There were no significant differences in the incidence of important health problems affecting the infants of the two groups. However, there were seven infant deaths, six of them were in the Uniplant group. Uniplant subdermal contraceptive implants can be offered as a new contraceptive option suitable for nursing mothers.

Adult↗
PubMed1975

Prevalence of gonorrhoea among women using various methods of contraception.

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

Adult↗
PubMed1979

Abortion associated with intrauterine infection by candida albicans. Case report.

A 27-year-old patient who became pregnant whilst fitted with an intrauterine contraceptive device developed an intrauterine Candida albicans infection and aborted. The diagnostic (and other inconspicuous) features of C. Albicans infection in the fetus are described. The presence of the intrauterine contraceptive device may have predisposed to the establishment of the infection.

Abortion, Spontaneous↗
PubMedDate not supplied

Adolescent pregnancy in the United States: a review and recommendations for clinicians and research needs.

Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. In 1987 over $19 billion in federal monies were expended on families begun when the mother was a teenager. The preferred approach to this problem is prevention of teenage pregnancy rather than abortion, with emphasis on sex education and access to family planning information and contraceptive devices for both females and males. Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.

Adolescent↗